How physicians can identify, assist human trafficking victims
Physicians may encounter human trafficking victims more often than they realize and are in a unique position to help put these children, women and men’s lives on a path to recovery. Learn the warning signs, ways to help patients you’ve identified as possible victims and resources available.
The U.S. Department of State estimates hundreds of thousands of people may be trafficked annually worldwide, the majority being women and children. One U.S. study on sex trafficking found that more than 85 percent of survivors had contact with a health care professional while being trafficked.
Among survivors, more than 60 percent reported going to a hospital or emergency department at some point. Survivors also reported visiting family physicians, internists and obstetrician-gynecologists in traditional physician offices, urgent care clinics, neighborhood clinics and women’s health clinics.
Yet a survey of nearly 500 resident physicians showed that fewer than 10 percent suspected that they had encountered a human trafficking victim, and only 20 percent said they would know what to do if they encountered a victim.
Physicians who are raising awareness about human trafficking say identifying someone who is being trafficked can be complicated.
“There is not one straightforward answer,” said Suzanne Harrison, MD, a family physician in Tallahassee, Fla., who has spent her career advocating for victims of violence. She is co-chair of Physicians Against the Trafficking of Humans (PATH), an anti-trafficking committee of the American Medical Women’s Association.
Some red flags may be that the patient:
- Experiences repeated STDs and/or pregnancies
- Has bruises, scars, burns and cuts—especially ones that are hidden
- Appears fearful, anxious or depressed
- Pays cash and has no health insurance
- Looks malnourished
- Brings a third party who speaks for them
- Shows signs of substance addiction or withdrawal
- Lies about his or her age, or says they are visiting or passing through
- Is tattooed with what may be the mark of a pimp or trafficker
Body language also may be a tip-off, said PATH’s creator and Executive Director Kanani Titchen, MD, an adolescent medicine fellow in New York City. Victims may give short answers to questions or seem confused. “Some of this can be normal, but it may be a clue to delve deeper with the patient,” she said. “We need to have our eyes and ears open.”
What to do once you’ve identified someone
Physicians shouldn’t be shocked at answers from patients and shouldn’t give a judgmental look, experts say. Instead, have an open manner, and remember trafficking victims often are not in control of their bodies or their lives.
“If our encounters are compassionate, we have a huge opportunity to make a difference in someone’s life,” said Dr. Harrison, who also is AMWA’s president-elect.
A few questions to open the dialogue include:
- Are you comfortable? Are you hungry?
- Where are you living? Who are you living with?
- Do you feel safe?
- Has anyone ever hit you or forced you to do something you didn’t want to do?
- Do you live, work and sleep in the same place?
- Have you ever traded anything for sex?
“Don’t be afraid of offending a patient,” Dr. Titchen said. “If they are not trafficked, they won’t be offended. If they are trafficked, they will be glad you asked.”
Find a way to separate the patient from the people who brought them in so they may be more comfortable talking, Dr. Harrison said. Physicians also need to remember that patient privacy can be a matter of life or death for many trafficking victims. And Drs. Harrison and Titchen said writing a patient a prescription for a follow-up medical visit is key. While a trafficking victim may not seek help on a first visit, they may open up at a later visit.
“This is … about helping them connect the dots,” Dr. Titchen said. “Usually we are going to be one little stone on a long path.”
Physicians can help get information to trafficking victims by putting pamphlets and posters in waiting and exam rooms. Face-to-face, physicians can give out a 24-hour hotline number in a way that’s easy to remember, such as this one offered by the National Human Trafficking Resource Center: (888) 3737-888. If a physician is going to write something down, it is best to put a phone number on a health card or write that the number is for a health service, such as the phone number to an x-ray facility.
In addition to PATH’s tools, physicians can find resources at The Polaris Project, which also operates the textline “BeFree.” The Department of Health and Human Services’ Office on Trafficking in Persons provides tools for health care professionals, and HEAL Trafficking connects interdisciplinary health professionals to fight human trafficking.
The National Human Trafficking Resource Center has a checklist of what to look for in the health care setting when trying to identify a human trafficking victim.
The National Academy of Medicine, formerly known as the Institute of Medicine, offers a guide to help health care professionals confront sexual exploitation and trafficking of minors. And the American Academy of Pediatrics last year published a clinical report on the health care needs of victims.
The AMA recently adopted policy that calls for educating physicians about human trafficking and teaching them how to report cases of suspected human trafficking to appropriate authorities to provide a conduit to resources to address the victim’s medical, legal and social needs.