HARVARD MEDICAL SCHOOL PRIMARY CARE REVIEW

Human Trafficking: A Review for Healthcare Providers

June 4th, 2020

Human trafficking is a global pandemic and gross violation of human rights. Healthcare providers are often the first group of professionals to interact with victims of human trafficking with over 88% of victims seeking medical care in a variety of healthcare settings. These healthcare professionals provide not only medical care for various concerns but also emotional and psychological support. 

The U.S. Department of State defines human trafficking in The Trafficking Victims Protection Act of 2000 as:

  • Sex trafficking in which a commercial sex act is induced by force, fraud, or coercion, or in which the person induced to perform such an act has not attained 18 years of age; or
  • The recruitment, harboring, transportation, provision, or obtaining of a person for labor or services through the use of force, fraud, or coercion for the purpose of subjection to involuntary servitude, peonage, debt bondage, or slavery.

Medical complaints often include infectious diseases, physical violence, sexual abuse, pelvic pain, hazardous working conditions, unintended pregnancies, abortions, malnutrition, dental disease, anxiety, chronic pain, posttraumatic stress disorder (PTSD), depression, substance use disorders, suicidal ideation, and suicide attempts. Unfortunately, many healthcare providers lack the knowledge and tools needed to recognize these victims. In this blog post, we will dive into some key information that all healthcare providers should know to identify victims of human trafficking. 

Risk Factors 

  • Poverty
  • Minority race/ethnicity
  • Disability
  • Lower educational status
  • Inadequate family support and protection
  • Rural location
  • Migration

Red Flags & Indicators 

  • Someone else is speaking for the patient and refuses to let the patient have privacy
  • Exhibits fear, anxiety, or tension
  • Reluctant to explain his/her injuries or describes a scripted/inconsistent history
  • Visible tattoos or other forms of branding
  • Reports an unusually high number of sexual partners, STIs, pregnancies, miscarriages, or terminations
  • Uses language [or slang] common in the commercial sex industry

Questions & Screening Tools 

  • What are your working and living conditions like?
  • Have you ever been deprived of food, water, sleep, or medical care?
  • Can you leave your job or situation if you want?
  • Can you come and go as you please?
  • Who is the person who came with you today? Can you tell me about them?
  • Have you ever been threatened or intimidated? 
  • Has anyone threatened to hurt you or your family if you leave? 
  • Do you have a debt to someone you cannot pay off? 
  • Is someone holding your identification documents (passport, visa, driver’s license)? 
  • Did you ever feel pressured to do something that you didn’t want to do or felt uncomfortable doing? 
  • Have you ever been told to have sex with people you don't want to have sex with?
  • Have you been forced to engage in sexual acts for money or favors? 
  • Does anyone take all or part of the money you earn? 
  • Do you have to meet a quota of money each night before you return home?

Approaching the Patient Interview

  • Conduct the assessment in a comfortable, private location with a social worker or advocate present whenever possible
  • Conduct the interview in the potential victim’s native language and use a professional, neutral interpreter if needed
  • Ask those accompanying the patient to leave for the interview and physical exam 
  • Use an approachable tone, demeanor, and body language that remains neutral and non-judgmental
  • Refrain from taking notes while in the room in order to promote active listening 
  • Assure confidentiality, unless the situation invokes state mandatory reporting laws (e.g. persons in grave danger, minors under the age of 18 years, or persons with disabilities)
  • Victims may find it easier to speak with a provider who is of the same gender, ethnicity, or age range
  • Reference existing institutional protocols for victims of abuse
  • Before you begin, do a safety check: 
    • Is it safe for you to talk with me right now? 
    • Do you feel safe right now? 
    • Do you feel like you are in any kind of danger for speaking with me?

Next Steps 

After addressing the immediate needs of your patient and obtaining informed consent, consider calling the National Human Trafficking Resource Center (NHTRC) hotline at 1-888-373-7888. The NHTRC can help assess current level of danger, provide further recommendations, identify local resources, and potentially involve law enforcement. In situations of life-threatening danger, follow your institutional policies for reporting to law enforcement.

Some items to consider include: 

  • Presence of the trafficker in patient room, waiting room, or home
  • Potential that calling the hotline may put the patient or the patient’s family in danger
  • Age of the patient

It is vital that you help the patient memorize the phone number, so they can call (1-888-373-7888) or text HELP or INFO to BeFree (233733) at a later time. Please avoid giving the patient physical materials including written notes or brochures that could place them at increased risk if detected. 

Healthcare providers are in a unique and powerful position to serve as first responders for victims of human trafficking. Because many healthcare professionals have shared concerns about the lack of quality training available on this topic, we are conducting research on providers’ self-reported knowledge about human trafficking. Please stay tuned for the results of our study in a future publication.

**Feature photo by NEOSiAM 2020 from Pexels

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Nicole McAmis Nicole E. McAmis is a medical student at Frank H. Netter MD School of Medicine, Quinnipiac University in the Class of 2021. She has interests in Emergency Medicine, Critical Care, and Interprofessional Education. 

 

 

Angela MirabellaAngela C. Mirabella is a medical student at Frank H. Netter MD School of Medicine, Quinnipiac University in the Class of 2022. She has interests in Internal Medicine, Primary Care, and Health Management & Leadership. 

 

 

Elizabeth McCarthyElizabeth M. McCarthy is a medical student at Frank H. Netter MD School of Medicine, Quinnipiac University in the Class of 2023. She has interests in Emergency Medicine, General Surgery, and Medical Humanities. 



Cara CamaCara A. Cama, MBA, is a medical student at Frank H. Netter MD School of Medicine, Quinnipiac University in the Class of 2021. She has interests in General Surgery, Interprofessional Education, and Healthcare Management.

 

 

 

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