Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Doctors need to recognize the signs of human trafficking. Here’s how.

Laura Janneck, MD and Hanni Stoklosa, MD
Conditions
May 15, 2016
Share
Tweet
Share

It was 2 a.m. on a typically hectic Friday overnight shift in the emergency department.

A young woman, Kelly, checked into triage, accompanied by her older boyfriend Jim, who explained that Kelly had abdominal pain and some vaginal bleeding. Jim wanted her checked out and maybe some pain medicine to help her rest at home.

Kelly had no identification. She appeared younger than her stated age of 18. I also noticed track marks punctuating both of her arms: a sign of IV drug use. She immediately looked to Jim after answering all my questions.

If this sounds suspicious, that’s because it is. While clinicians are trained to address Kelly’s medical ailment, many of us fail to recognize the larger social cues right in front of us. It appears that Jim is in control of the situation. Kelly is young, maybe very young. As a clinician I must consider Kelly’s living situation, and her relationship with Jim.

As emergency care providers, it is standard practice for us to separate patients from their visitors long enough to at least ask about domestic violence. And for most of us, that would likely be the first concern in this case. But Kelly is actually a victim of human trafficking.

By definition, human trafficking, sometimes referred to as modern day slavery, is the recruitment, transportation and harboring of persons by means of force, fraud, coercion or deception. And while many assume trafficking is the movement of people across international borders, in reality many victims never leave their hometowns.

Victims are found in domestic service, nail salons, massage parlors, restaurants, the sex trade, as well as farm and factory work. Few people realize the Northeast is one of the nation’s human trafficking hot spots. We have seen the magnitude of the problem in our region further compounded by the opioid epidemic.

Several studies show that most trafficking victims receive medical care while being trafficked, with the majority showing up in the ER. We expect emergency providers to recognize and address many public health ills, and the time has come to add human trafficking to the list.

Identifying cases, and the physical signs

Unfortunately, most of us on the front lines lack the training to even recognize the signs of trafficking — let alone what to do when a case is confirmed.

Part of the challenge in identifying cases is that they all look different. On Monday, I could see a foreign-born woman or girl being sexually exploited. Tuesday, it could be a man working as a domestic servant who grew up in the area.

Force, fraud, coercion and deception obviously can take a variety of forms, and health care providers must learn to think more broadly than most of us do today. Going back to Kelly’s situation, there were several opportunities to ask questions to get a sense of her daily life.

It could have been something as simple as, “How do you pay for your drugs?” Working in emergency departments around Boston, we encounter patients struggling with heroin addiction often — sometimes several times in a shift. Finding out how they get their drugs may open up a broader conversation about whether this person in your exam room is trapped, forced to do something he or she doesn’t want to do.

ADVERTISEMENT

We must train ourselves to notice the nuanced clues of exploitation on our patient’s bodies. Signs of trafficking can be subtle, such as track marks from heroin use, or more obvious, such as facial hematomas from being pistol whipped while raped.

In addition to signs of physical violence and STDs, trafficked patients may have chronic infections, dehydration, malnutrition and the stigmata of trauma and psychological stress.

The response

I have never met a patient who called himself a victim of human trafficking. As with victims of domestic violence, many may not acknowledge the true nature of their situation. The sense of shame they feel is profound. And many decline intervention or services. The goal for us as health care providers is not rescue. First and foremost, we need to communicate that the health care setting is a safe place for them to seek help when they do want it, and to ensure — with the support of our hospitals and departments — that it actually is. Whenever possible, involving our social worker colleagues can help us navigate potential options for these complex patients.

The response to children, it should be noted, is unique. In Massachusetts, and in many other states, suspected child victims of human trafficking must be reported to the Department of Children and Families. In Massachusetts, that report will trigger a multidisciplinary team response to help meet the trafficked child’s needs.

Providers and victims should utilize the National Human Trafficking Resource Center Hotline. This hotline is meant as a resource to both victims themselves, and for health workers and others looking for support in helping potential victims. The hotline can advise providers and their patients on local resources such as shelter, and provide continued guidance through the process.

We encourage our colleagues in health care, particularly in emergency departments around the region, to be vigilant for the trafficking victims that come through our doors. Human trafficking is an egregious form of suffering that health care providers are only starting to grapple with recognizing and addressing. Clinicians should know that support is there, for their victims and for them, as they continue to serve the most vulnerable and exploited people in our society.

More resources

The National Human Trafficking Resource Center recently published three resources for health care professionals about human trafficking:

  • a recorded presentation
  • an assessment tool
  • a fact sheet for clinicians

Or you can join others combating trafficking through HEAL Trafficking, a national network of professionals improving the public health response to trafficking.

Editor’s Note: The names used in this story are not the real names of the individuals involved.

Laura Janneck is an emergency medicine physician.  Hanni Stoklosa is an emergency physician and executive director, HEAL Trafficking.  This article originally appeared in WBUR’s CommonHealth.

Image credit: Shutterstock.com

Prev

This is why we are driving doctors to suicide

May 15, 2016 Kevin 3
…
Next

Foreign policy through the lens of an emergency physician

May 15, 2016 Kevin 1
…

Tagged as: Emergency Medicine

Post navigation

< Previous Post
This is why we are driving doctors to suicide
Next Post >
Foreign policy through the lens of an emergency physician

ADVERTISEMENT

Related Posts

  • Is health care just legal human trafficking?

    Debra Blaine, MD
  • Why do doctors who hate being doctors still practice?

    Kristin Puhl, MD
  • Doctors: It’s time to unionize

    Thomas D. Guastavino, MD
  • The medical student who had a genuine human profile

    DrizzleMD
  • When doctors are right

    Sophia Zilber
  • Be a human first and a doctor second

    Sarah Murad

More in Conditions

  • Why telling kids to eat less and move more fails to address obesity

    Callia Georgoulis
  • Clinical ghosts and why they haunt our exam rooms

    Kara Wada, MD
  • High blood pressure’s hidden impact on kidney health in older adults

    Edmond Kubi Appiah, MPH
  • How declining MMR vaccination rates put future generations at risk

    Ambika Sharma, Onyi Oligbo, and Katrina Green, MD
  • How one unforgettable ER patient taught a nurse about resilience

    Kristen Cline, BSN, RN
  • Why regular exercise is the best prescription for lifelong health

    George F. Smith, MD
  • Most Popular

  • Past Week

    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • The shocking risk every smart student faces when applying to medical school

      Curtis G. Graham, MD | Physician
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • Harassment and overreach are driving physicians to quit

      Olumuyiwa Bamgbade, MD | Physician
    • Why so many doctors secretly feel like imposters

      Ryan Nadelson, MD | Physician
    • Why peer support can save lives in high-pressure medical careers

      Maire Daugharty, MD | Conditions
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
  • Recent Posts

    • Why so many doctors secretly feel like imposters

      Ryan Nadelson, MD | Physician
    • Why telling kids to eat less and move more fails to address obesity

      Callia Georgoulis | Conditions
    • Why enterprise risk management is key to value-based health care success

      Olumuyiwa Bamgbade, MD | Physician
    • Rethinking physician resilience for sustainable well-being

      Sarah Webber, MD | Physician
    • How shared language saved a patient from isolation

      Syed Ahmad Moosa, MD | Physician
    • The shocking risk every smart student faces when applying to medical school

      Curtis G. Graham, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • The shocking risk every smart student faces when applying to medical school

      Curtis G. Graham, MD | Physician
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • Harassment and overreach are driving physicians to quit

      Olumuyiwa Bamgbade, MD | Physician
    • Why so many doctors secretly feel like imposters

      Ryan Nadelson, MD | Physician
    • Why peer support can save lives in high-pressure medical careers

      Maire Daugharty, MD | Conditions
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
  • Recent Posts

    • Why so many doctors secretly feel like imposters

      Ryan Nadelson, MD | Physician
    • Why telling kids to eat less and move more fails to address obesity

      Callia Georgoulis | Conditions
    • Why enterprise risk management is key to value-based health care success

      Olumuyiwa Bamgbade, MD | Physician
    • Rethinking physician resilience for sustainable well-being

      Sarah Webber, MD | Physician
    • How shared language saved a patient from isolation

      Syed Ahmad Moosa, MD | Physician
    • The shocking risk every smart student faces when applying to medical school

      Curtis G. Graham, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...