A young woman comes into an emergency room, trailed by a much older boyfriend who answers questions for her. A man with a broken ankle and no identification asks a doctor to promise the hospital will not tell his employer that he sought medical care.
These are just a couple scenarios that doctors and nurses were asked to consider Thursday during a training session to spot victims of sex and labor trafficking when they seek medical care. A recent study in the Annals of Health Law concluded that victims of sex trafficking in particular had frequent contact with medical professionals in emergency rooms and women’s health clinics, but were very rarely identified.
“The public in general doesn’t think this is happening in St. Louis, with American girls,” said Dr. Ann DiMaio, an Emergency Department physician at Cardinal Glennon Hospital, who attended the training at the Goldfarb School of Nursing in St. Louis. “The same thing is going on in health care. They think, 'Oh no, this is not happening. This couldn’t be happening, not in my hospital.'”
When police officers began to bring child victims of sex trafficking to DeMaio for medical care, she and her colleagues realized that they could learn how to identify victims while they’re still in a dangerous situation. They have also provided care for women and girls who have recently escaped a trafficking situation, and are now living at a local shelter called Covering House.
“I’m sure we’ve had victims in the ER who, years ago, we never recognized, which is so sad,” DeMaio said. “In retrospect, I think about that girl with the boyfriend or that girl with the aunt, and I wonder if some of those girls weren't victims.”
To spot a victim of sex trafficking, doctors and nurses learn to look for signs of ongoing physical abuse, or a controlling partner or family member. In labor trafficking situations, a person may not know which city they are in, or they may owe a large debt to their employer.
“Healthcare providers need to know that when a trafficking victim comes to a healthcare setting, [the providers] are in a super-unique position to identify them and care for them, and maybe even prevent somebody who’s vulnerable to being trafficked from becoming trafficked,” said Dr. Hanni Stoklosa, a Boston-based emergency physician who came to St. Louis to lead Thursday’s seminar. Stoklosa is also a co-founder of HEAL Trafficking, a network of health providers who advocate for the issue.
One step to recognize trafficking is becoming aware of common misperceptions of who a victim would be. Though statistics are nearly impossible to come by, local advocates believe men and boys are trafficked for sex at the same rate as women and girls. Large agricultural operations and meat packing plants tend to grab the headlines for labor trafficking violations, but victims have also been identified in nail salons and landscaping companies.
Once a potential victim is identified, Stoklosa cautioned doctors against rushing in and immediately trying to save someone.
“It’s very similar to how I think about intimate partner violence,” Stoklosa said. “That individual knows his or her safety situation better than I do — I can only see what’s in the room, I don’t know the threats, the violence exerted against them or threats against their family.”
Instead, Stoklosa said healthcare professionals need to let patients know they’ll work with them to come up with a safe plan for exit when they’re ready. If a person is a victim of human trafficking, they are eligible for victim services and other benefits that can help them get back on their feet. But, Stoklosa added, letting someone go back into the hands of traffickers is “one of the hardest things we do.”
Other times, a doctor might be limited by the resources available. Stoklosa recalled a patient she tended to in Boston who was identified as a victim of sex trafficking, and also had a heroin addiction. There were no beds available for addiction treatment, so when the woman started going into withdrawal, she left the hospital against doctor’s advice.
“That was a case where we failed her, the system failed her. She was asking for help and we didn’t have the substance abuse treatment she needed as a trafficking victim,” Stoklosa said.
If you or someone you know may be a victim of human trafficking, the National Human Trafficking Resource Center hotline is 1-888-3737-888.
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