Angelika Dabu
Public Health
Dr. Deo
January 22, 2020
The Need for a More Informed Response to Human Trafficking in Healthcare
Human trafficking is a serious human rights issue, let alone crime, that often presents in healthcare settings whether providers realize it or not. Though men are among susceptible victims, human trafficking predominantly involves the exploitation of vulnerable women and children, many of whom seek treatment for their symptoms in hospital emergency departments (EDs). As this is a sensitive problem that can present in a number of complex ways, greater awareness and knowledge of clinical warning signs, interventions and resources to appropriately respond must be more widely understood in order to provide safety to victims. Guidance on how to properly care for them is currently lacking.
Human trafficking is a global problem through which healthcare has the potential to intervene. It is defined as the often forceful or manipulative recruitment and transportation of people for exploitation commonly for the purposes of sex work, domestic servitude, labor, and criminal activity (Hemmings et al., 2016, 2). The notable signs of physical and sexual abuse related to human trafficking are broken bones, burns, chronic pelvic and sexually transmitted infections, language barriers, absence of documentation, fear of deportation, inconsistent stories, and the company of a controlling individual (Hemmings et al., 2016, 4). Often times, victims present for acute care in EDs, making health care providers more likely than most other people to interact with them and be able to offer means for intervention and safety (Dovydaitis and Kirschstein, 2010, 1). These same health care providers have become increasingly vital in identifying and treating intimate partner violence (IPV) victims as awareness and knowledge of IPV have grown (Patel et al., 2010, 402). Thus, equal, if not stronger measures, must be taken to ensure the appropriate level of care be administered in human trafficking cases as has been to advance IPV victims’ care.
Because there is no classic case presentation of signs and symptoms representative of human trafficking, it is possible that subtleties be missed. While some victims display overt physical symptoms of violence and abuse, others may not, as such abuse can be mentally and emotionally inflicted (Zimmerman et al., 2011, 330). Thus, evidence of this abuse may be overlooked and insufficiently explored or treated. This is especially concerning as qualitative research suggests that mental health professionals feel inadequate in being able to confidently and appropriately respond to trafficked victims as well as refer them to support services (Domoney et al., 2015, 2). As a result, victims with depression, post-traumatic stress disorder (PTSD), pre-trafficking childhood abuse, sexual and physical violence, and other psychological symptoms and co-morbidities may not receive the specialized diagnostic care they need (Le, 2018, 259).
Therefore, it is evident that significant research and measures to more comprehensively educate all health care providers in order to effectively identify possible human trafficking victims be pursued, especially given the many complexities cases may involve. As evidenced by a study conducted in the San Francisco Bay Area, ED providers determined that human trafficking is important to the profession, and when presented with educational information, became increasingly able to identify potential victims and utilize resources to manage their cases (Grace et al., 2014, 7). Given the fact that the aspects of power and control associated with human trafficking closely mirror that of IPV, the measures and treatment found to be successful for IPV victims may inform the development of the needed education and response for human trafficking (Ahn et al., 2013, 284).
A number of strategies may prove to further this cause that involve both incentives as well as the collaboration of various health care team members. For instance, to increase and generalize awareness, hospitals may offer continuing education credit to health care providers for reading or reviewing trafficking-related resource materials (Ahn et al., 2013, 287). As was tested in the San Francisco Bay Area EDs study, presentation materials viewed and/or distributed in Grand Rounds and department meetings have shown to be an effective means of education. Education may also begin in medical programs so that students have the awareness before they enter the field and begin to practice. This early exposure will inform their ability to appropriately respond as the understanding of human trafficking and effective responses evolve. Additionally, the use of medical interpreters may be beneficial not only in picking up subtleties in victims’ narratives but also in facilitating victims’ disclosure and referral to needed services (Hemmings et al., 2016, 4). This may assist mental health professionals who may, as mentioned, have difficulty in their response and referral. Therefore, an inter-professional team-based approach involving first contact providers, mental health professionals, social workers, case managers and medical interpreters may allow for a more informed response to human trafficking treatment and trauma.
It is perhaps of utmost importance that providers be cognizant of those accompanying potential victims and have protocol in place to maximize patient privacy. This will help build trust and elicit information that may indicate the circumstance of trafficking with the hope of disclosure. It was found that child and adolescent survivors often felt they received insensitive, substandard care and did not understand the treatment they received or the purposes of them (Garg et al., 2019, 8). Therefore, healthcare settings must work to create safe spaces that encourage open communication and caring concern regardless of demographic factors, such as age. Furthermore, they must meet victims with trauma-informed care in order to optimize the opportunity to intervene and offer safety to those who feel comfortable to share their unfortunate reality. This may be achieved through shared decision making, as the invitation for active participation gives victims the opportunity to exercise a sense of autonomy they do not normally have.
Of course, determining the most effective measures comes with challenges. Time plays a significant factor as providers, especially in busy settings such as EDs, do not currently have the amount of time needed to thoroughly and effectively identify potential victims. Measures to allow increased time for more sensitive cases must be developed and implemented as a result. This will require a reimagining of traditional health care services so that flexibility in time allowed and coordinated multidisciplinary care support the opportunity to identify possible victims (Jude et al., 2018, 662). It will be through the concerted effort of multiple health care team members that this can be achieved. Moreover, consideration for financially unstable victims, which is the case for most if not all victims, must be taken into account as access to care and necessary resources may be limited and present as barriers to sustain a life outside trafficking. Thus, assistance to maintain the continued support victims may need must be incorporated in their care management and treatment.
As human trafficking is a pervasive, global issue that affects an incredible amount of people in vulnerable circumstances, it can no longer be ignored or excused by ignorance. Health care providers have the special opportunity to be able to identify victims and treat them with the care they need. Thus, a healthy sense of suspicion may be crucial, as it cannot be assumed that patients are always accompanied by a friend, spouse, or family member. It can be easy to maintain ignorance in a busy, chaotic setting such as the ED, which is why necessary education and protocol must be implemented to account for the possibility of human trafficking cases. As symptoms may not be physically visible, it is important that mental health be carefully assessed. In consequence, the need to increase provider preparedness and awareness to effectively identify suspected cases of human trafficking so as to appropriately respond must be fulfilled to hopefully change the course of victims’ lives for the better.
References
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(http://www.sciencedirect.com/science/article/pii/S014521341930314X)
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