The Effects of Human Trafficking and Healthcare Providers

Freedom is inarguably the most treasured right in the United States. But each year, roughly 18,000 men, women and children are trafficked in the United States. Human trafficking is a public health concern that affects individuals, families and entire communities across generations. The health care system plays an important role in identifying and treatment victims of human trafficking; however, how trained are the medical professionals on how to identify and properly treat the victims to ensure a successful recovery? What is the definition of trafficking? The most widely accepted definition of ‘trafficking in persons’ is found in the Protocol to Prevent, Suppress, and Punish Trafficking in Persons, Especially Women and Children, Supplementing the United Nations Convention against Transnational Organized Crime:

•  “Trafficking in persons” shall mean the recruitment, transportation, transfer, harboring or receipt of persons, by means of the threat or use of force or other forms of coercion, of abduction, of fraud, of deception, of the abuse of power or of a position of vulnerability or of the giving or receiving of payments or benefits to achieve the consent of a person having control over another person, for the purpose of exploitation. Exploitation shall include, at a minimum, the exploitation of the prostitution of others or other forms of sexual exploitation, forced labor or services, slavery or practices similar to slavery, servitude or the removal of organs;
• The consent of a victim of trafficking in persons to the intended exploitation set forth in subparagraph  of this article shall be irrelevant where any of the means set forth in subparagraph have been used;
• The recruitment, transportation, transfer, harboring or receipt of a child for the purpose of exploitation shall be considered “trafficking in persons” even if this does not involve any of the means set forth in subparagraph (a) of this article;
• “Child” shall mean any person under eighteen years of age. As human trafficking continues to be on the rise, it is more essential than ever to ensure healthcare providers are properly trained and proficient in identifying the signs and symptoms of abuse in order to assist the victims while they have that opportunity.

The American Associates of Pediatrics conducted a survey which included physicians, nurses, social workers, and physician assistants and found the 63% of respondents did not have training on how to identify and treat victims. “Healthcare providers have the potential to play a crucial role in human trafficking prevention, identification, and intervention. However, trafficked patients are often unidentified due to lack of education and preparation available to healthcare professionals at all levels of training and practice.”

According to US Studies 25 to 88% of human trafficking victims have been seen by a healthcare provider while being exploited. The lack of knowledge and training has been detrimental to the victims. Most healthcare facilities don’t have any specific guidelines or treatment plans laid out that outlines what to look for in cases of human trafficking. Chances are only 13% of healthcare professionals will be able to recognize a victim of human trafficking. The biggest barrier between providers and victims is their capturers. Most victims are threatened into silence with fear of death or harm to their family. Because human trafficking is such a complex issue that doesn’t affect just one gender, ethnicity or social status it makes it extremely difficult to lay out a broad guideline to healthcare providers to follow. It is difficult to track and create a standardized screening tools for many reasons with one of the main reasons being underreporting, however, efforts are underway to change that. Medical colleges have now implemented a human trafficking intervention into their curriculum. This curriculum aims to introduce possible management strategies for victims incorporating diagnosis framework. Most curriculum revolves around simulation-based approaches to practicing and intervention of human trafficking. While this curriculum is a start, evidence-based approaches are still lacking.

Human trafficking is the largest growing criminal organization and it is important for the healthcare providers and communities to be aware, educated and trained to assist these victims when the opportunity arises. Because most healthcare providers believe that human trafficking is rare and are not regularly predisposed to cases in which human trafficking is occurring, often times victims can be overlooked or under diagnosed in many cases and sent back to their abuser without anyone ever thinking twice. However, once the victims have been identified it is important for the healthcare provider to act to assist them in the best way possible because there is a very small window of opportunity.

The National Human Trafficking Resource Center (NHTRC) lays out the five most important steps healthcare providers need to take to ensure proper treatment of victims. The most important step is to know what local resources are available that might benefit the patient and provide them with encouragement and support. The healthcare provider should not be discouraged if a victim does not disclose their victimization, instead they must accept their patients fears. “Healthcare providers shouldn’t try to ‘rescue’ the patient, inquire about their immigration status, make promises that cannot be kept, [or] force/deceive/ coerce a patient into rescue,” she says. “Healthcare providers also shouldn’t be discouraged if a patient does not disclose their victimization and should not let it deter them from reporting in the future.” Healthcare providers should respond in a sensitive and private manner to patients believed to be victims of human trafficking.

Providing care for victims can be challenging for healthcare providers due to the magnitude of diagnostic prevention. Caring for a patient who has been a victim of human trafficking requires special attention to detail, including the individual’s health, safety and well-being that often goes well beyond the basic principle of ‘do no harm’. It is also important for healthcare providers to provide culturally sensitive care to patients who may have been trafficked from another country. There are resources available in the clinical setting to ensure that the proper care is provided which include interpreters, social workers, and varied religious delegates. Because patients may not always be honest out of shame or fear, it is imperative that the healthcare professional be vigilant and look for other medical concerns that were not mentioned in the medical history. In addition, it is imperative to remember that physical exams may lead to flashbacks in some patients. This could be especially difficult if the patient exam requires forensic evidence to be collected.

Healthcare providers may not be able to recue every patient that they encounter that is an active victim of human trafficking and they must realize that they cannot be responsibility is not theirs alone. They must simply provide them with the best possible medical care they can and ensure the patient is properly informed of their human rights and provided with the necessary resources that are available to them. A basic principle in aiding trafficked victim is that actions and services should be conducted within what is known as a ‘sphere of protection’. This means prioritizing safety and security during the assistance and referral process, including trying to protect victims from harm, threats or intimidation by traffickers or their associates. To identify a patient as a trafficking victim without a plan in place to adequately address their complex needs can endanger the patient and potentially do more harm than good for them. A well-functioning network of resources should already be established, because that is crucial in assisting victims in their freedom.

Healthcare providers need to know who to call and where the victims can be provided quality resources to ensure a successful recovery. Most hospitals have a safety protocol that they follow to ensure the safety of their patients and staff members if problems should arise; that protocol should be followed to ensure the safety of everyone involved. Healthcare providers should be familiar with and have contact information to The National Human Trafficking Hotline, which can provide additional resources and help to the victims. In 2018 more than 847 calls were made to NHTH and nearly 450 human trafficking cases were reported in the state of Texas. 355 of those calls were to report a human trafficking tip and 60 were requesting crisis intervention resources. That shows that networking and familiarization by healthcare providers and communities alike is growing and the necessary knowledge it being provided.

Providing support to people who have been trafficked is usually a highly rewarding experience. However, exposure to graphic details of abuse and to the ways in which abuse affects the lives of those who have been trafficked can be stressful for health providers. Hearing about extreme trauma can change a health provider’s view of the world, of other people and of him- or herself. The provider may see the world as a more dangerous place, lose trust in other people and experience feelings of personal helplessness and hopelessness. Health care providers may react to such changes by distancing themselves from their patients and experiencing what is known as ‘compassion fatigue’, a reduced capacity or interest in being empathic or in bearing the suffering of patients. Compassion fatigue among health care providers also encompasses symptoms of job burnout. This is characterized by emotional exhaustion and reduced personal accomplishment in response to prolonged exposure to demanding interpersonal situations without adequate support.