Human Trafficking:Clinical Presentation & Treatment How to Care for Trafficked Persons in the E.D. MakiniChisolm-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.”
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 Types of Trafficking
Trafficking Affects (Populations at Risk): • 15,000 – 60,000 people are trafficked into the • U.S. annually • 80% of trafficked persons are ♀& children • U.S. citizens • 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
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) Signs & Sx
What to do What to do • building trust is the number one priority • reassure the potential victim • one-on-one interactions are ideal • specifically ask about the patient’s 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 doesn’t 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: email@example.com: www.polarisproject.orgor www.humantraffickingED.com