Human Trafficking: Clinical Presentation & Treatment

How to Care for Trafficked Persons in the E.D.

Makini Chisolm-Straker, MSII Brown Medical School, Mt. Sinai School of Medicine 2007

Instructional Goals:
You will be familiar with the clinical presentation of human trafficking victims in the E.D. in the U.S. You will be familiar with the appropriate treatment of human trafficking victims. You will appreciate the role of emergency healthcare practitioners in facilitating the escape of trafficked persons.

Instructional Learning Objective (what you will do by the end of this session): You will know the hotline to call when a suspected trafficking victim presents to the emergency department.

Case
obtunded teenage , GCS 5 extensive bleeding from vaginal canal visible burns, cuts, scars on wrists, ankles, neck hx of schizophrenia? bro. concerned about a dangerous abortion attempt

Human Trafficking is:

the recruitment, transportation, transfer, harboring or receipt of persons: by the threat or use of kidnapping, force, fraud, deception or coercion, or by the giving or receiving of unlawful payments or benefits to achieve the consent of a person having control over another person, and for the purpose of sexual exploitation or forced labor.

Human Trafficking is:

the illegal use of a variety of means

to force an individual (the trafficked)

to relinquish his/her personal freedom

for the profit of another person (the trafficker). often, simply considered involuntary servitude or modern-day slavery.

Types of Trafficking
Sexual Exploitation prostitution pornography bride trafficking commercial abuse of children massage parlors, hostess clubs, brothels, escort services, commercial phone sex & internet dating exotic dancing/stripping

Types of Trafficking
Forced Labor domestic servitude (domestic work & child care) manual labor
-small-scale factory work -construction work -sweatshops & farms of multinational corps -agricultural & landscape work

restaurants nail salons hotel housekeeping

false adoption drug trade street begging camel jockeys child soldiers organ harvesting

15,000 60,000 people are trafficked into the U.S. annually 80% of trafficked persons are & children U.S. citizens

Trafficking Affects (Populations at Risk):

U.S. residents
documented immigrants undocumented immigrants youth (esp. runaways) urban pop.

suburban pop.

Role of Healthcare Practitioners in the E.D.

Identify human trafficking victims
Treat the chief complaint/illness and/or the emergent issue Offer (& provide, if patient-desired) appropriate treatment for the unsafe environment

Difficulty Identifying Trafficking Victims

distrust of service providers lies & false stories untrustworthy interpreters one shot difference between intimate partner violence & human trafficking

Signs & Sx
lack of knowledge of a given community/whereabouts not in control of personal ID few no personal possessions does not speak 3rd party insists on being present or interpreting injuries (multiple, old & new) signs of malnourishment branding

Signs & Sx
no healthcare under 18 & in sex industry DE FACTO claim of just visiting inconsistent story behavior change when law enforcement is mentioned STIs bacterial &/or yeast infxns demeanor (e.g.: fearful, anxious, submissive, flat affect)

What to do
What to do
1. 2. 3. 4. 5. 6. 7. building trust is the number one priority reassure the potential victim one-on-one interactions are ideal specifically ask about the patients safety offer reworded stories stay calm & even-keel ALWAYS document your suspicion in your notes, at the very least

8. Call a Help Hotline:

English: 1-866-US-TIPLINE
Korean: 1-888-976-5274 Spanish: 1-888-80-AYUDA

The folks working at the hotlines are trained to know how to help you, but you are their eyes & ears. Trust their knowledge, your experience & your gut. If the patient is an adult, they have the last say, but give them every opportunity to receive help.

Even if a potential victim doesnt want help, call: 1 - 8 6 6 - U S - T I P L I N E, to report suspected trafficking; the tip can save lives.

Clinical Recommendations*
Presumptive Treatment for: gonorrhea chlamydia trichomoniasis syphilis UTI
*for sexually exploited victims

Special thanks to Polaris Project for the images & information. Clinical Recommendations courtesy of Doctors of the World.

For more information on trafficking in the U.S. you can: email: m.chisolmstraker@gmail.com visit: www.polarisproject.org or www.humantraffickingED.com