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Human Trafficking: Clinical Presentation and Treatment
- 1. Human Trafficking:Human Trafficking: Clinical PresentationClinical Presentation && TreatmentTreatment How to Care forHow to Care for Trafficked Persons in theTrafficked Persons in the E.D.E.D. Makini Chisolm-Straker, MSIVMakini Chisolm-Straker, MSIV Brown Medical School, Mt. Sinai School of MedicineBrown Medical School, Mt. Sinai School of Medicine 20082008
- 2. Instructional Goals:Instructional Goals: • You will be familiar with theYou will be familiar with the clinical presentationclinical presentation ofof human trafficking victims in the E.D. in the U.S.human trafficking victims in the E.D. in the U.S. • You will be familiar with the appropriateYou will be familiar with the appropriate treatmenttreatment ofof human trafficking victims.human trafficking victims. • You will appreciate the role of emergency healthcareYou will appreciate the role of emergency healthcare practitioners in facilitating the escape of traffickedpractitioners in facilitating the escape of trafficked persons.persons.
- 3. Instructional Learning ObjectiveInstructional Learning Objective (what you will do by the end of this session):(what you will do by the end of this session): You will know the hotline to call whenYou will know the hotline to call when a suspected trafficking victima suspected trafficking victim presents to the emergencypresents to the emergency department.department.
- 4. CaseCase • obtunded teenageobtunded teenage , GCS 5♀, GCS 5♀ • extensive bleeding from vaginal canalextensive bleeding from vaginal canal • visible burns, cuts, scars on wrists,visible burns, cuts, scars on wrists, ankles, neckankles, neck • h/o schizophrenia?h/o schizophrenia? • bro. concerned about a dangerousbro. concerned about a dangerous abortion attemptabortion attempt
- 5. Human Trafficking is:Human Trafficking is: • the recruitment, transportation, transfer, harboringthe recruitment, transportation, transfer, harboring or receipt of persons:or receipt of persons: – by the threat or use of kidnapping, force, fraud,by the threat or use of kidnapping, force, fraud, deception or coercion, or by the giving or receivingdeception or coercion, or by the giving or receiving of unlawful payments or benefitsof unlawful payments or benefits – to achieve the consent of a person having controlto achieve the consent of a person having control over another person,over another person, andand – for the purpose of sexual exploitation or forcedfor the purpose of sexual exploitation or forced labor.labor.
- 6. Human Trafficking is:Human Trafficking is: • the illegal use of a variety of meansthe illegal use of a variety of means • to force an individual (the trafficked)to force an individual (the trafficked) • to relinquish his/her personal freedomto relinquish his/her personal freedom • for the profit of another person (thefor the profit of another person (the trafficker).trafficker). • often, simply considered “involuntaryoften, simply considered “involuntary servitude” or “modern-day slavery.”servitude” or “modern-day slavery.”
- 7. Types of TraffickingTypes of Trafficking Sexual ExploitationSexual Exploitation • prostitutionprostitution • pornographypornography • bride traffickingbride trafficking • commercial abuse of childrencommercial abuse of children • massage parlors, hostess clubs, brothels,massage parlors, hostess clubs, brothels, escort services, commercial phone sex &escort services, commercial phone sex & internet datinginternet dating • exotic dancing/strippingexotic dancing/stripping
- 8. Types of TraffickingTypes of Trafficking Forced LaborForced Labor • domestic servitude (domestic work & childdomestic servitude (domestic work & child care)care) • manual labormanual labor -small-scale factory work-small-scale factory work -construction work-construction work -sweatshops & farms of multinational corps-sweatshops & farms of multinational corps -agricultural & landscape work-agricultural & landscape work • restaurantsrestaurants • nail salonsnail salons • hotel housekeepinghotel housekeeping • false adoptionfalse adoption • drug tradedrug trade • street beggingstreet begging • camel jockeyscamel jockeys • child soldierschild soldiers • organ harvestingorgan harvesting
- 9. Trafficking AffectsTrafficking Affects (Populations at Risk):(Populations at Risk): •15,000 – 60,000 people are trafficked into the15,000 – 60,000 people are trafficked into the U.S. annuallyU.S. annually •80% of trafficked persons are80% of trafficked persons are ♀♀ & children& children •U.S. citizensU.S. citizens •U.S. residentsU.S. residents •documented immigrantsdocumented immigrants •undocumented immigrantsundocumented immigrants •youth (esp. runaways)youth (esp. runaways) •urban pop.urban pop.
- 10. Role of Healthcare PractitionersRole of Healthcare Practitioners in the E.D.in the E.D. • IdentifyIdentify human trafficking victimshuman trafficking victims • TreatTreat the chief complaint/illness and/or thethe chief complaint/illness and/or the emergent issueemergent issue • OfferOffer (& provide, if patient-desired) appropriate(& provide, if patient-desired) appropriate treatment for the unsafe environmenttreatment for the unsafe environment
- 11. Difficulty Identifying Trafficking VictimsDifficulty Identifying Trafficking Victims • distrust of service providersdistrust of service providers • lies & false storieslies & false stories • untrustworthy interpretersuntrustworthy interpreters • ““one shot”one shot” • difference between intimate partner violence &difference between intimate partner violence & human traffickinghuman trafficking
- 12. Signs & SxSigns & Sx • lack of knowledge of a given community/whereaboutslack of knowledge of a given community/whereabouts • not in control of personal IDnot in control of personal ID • fewfew no personal possessionsno personal possessions • does not speakdoes not speak • 33rdrd party insists on being present or interpretingparty insists on being present or interpreting • injuries (multiple, old & new)injuries (multiple, old & new) • signs of malnourishmentsigns of malnourishment • brandingbranding
- 13. Signs & SxSigns & Sx • no healthcareno healthcare • under 18 & in sex industry – DE FACTOunder 18 & in sex industry – DE FACTO • claim of “just visiting”claim of “just visiting” • inconsistent storyinconsistent story • behavior change when “law enforcement” is mentionedbehavior change when “law enforcement” is mentioned • STIsSTIs • bacterial &/or yeast infxnsbacterial &/or yeast infxns • demeanor (e.g.: fearful, anxious, submissive, flatdemeanor (e.g.: fearful, anxious, submissive, flat affect)affect)
- 14. What to do 1.1. building trust is the number one prioritybuilding trust is the number one priority 2.2. reassure the potential victimreassure the potential victim 3.3. one-on-one interactions are idealone-on-one interactions are ideal 4.4. specifically ask about the patient’s safetyspecifically ask about the patient’s safety 5.5. offer reworded storiesoffer reworded stories 6.6. stay calm & even-keelstay calm & even-keel 7.7. ALWAYS document your suspicion in yourALWAYS document your suspicion in your notes, at the very leastnotes, at the very least What to doWhat to do
- 15. 8. Call a Help Hotline:8. Call a Help Hotline: English: 1-888-373-7888English: 1-888-373-7888 Korean: 1-888-976-5274Korean: 1-888-976-5274 Spanish: 1-888-80-AYUDASpanish: 1-888-80-AYUDA
- 16. The folks working at the hotlines are trained to knowThe folks working at the hotlines are trained to know how to help you, but you are their eyes & ears.how to help you, but you are their eyes & ears. Trust their knowledge, your experience & your gut.Trust their knowledge, your experience & your gut. If the patient is an adult, they have the last say, butIf the patient is an adult, they have the last say, but give them every opportunity to receive help.give them every opportunity to receive help. Even if a potential victim doesn’t want help,Even if a potential victim doesn’t want help, call:call: 1 - 8 8 8 - 3 7 3 - 7 8 8 8,1 - 8 8 8 - 3 7 3 - 7 8 8 8, to report suspected trafficking;to report suspected trafficking; the tip can save lives.the tip can save lives.
- 17. Clinical Recommendations*Clinical Recommendations* Presumptive Treatment for:Presumptive Treatment for: • gonorrheagonorrhea • chlamydiachlamydia • trichomoniasistrichomoniasis • syphilissyphilis • UTIUTI *for sexually exploited victims*for sexually exploited victims
- 18. Special thanks to Polaris ProjectSpecial thanks to Polaris Project for the images & information.for the images & information. Clinical Recommendations courtesy ofClinical Recommendations courtesy of Doctors of the World.Doctors of the World.
- 19. For more information onFor more information on trafficking in the U.S.trafficking in the U.S. you can:you can: email: m.chisolmstraker@gmail.comemail: m.chisolmstraker@gmail.com visit: www.polarisproject.orgvisit: www.polarisproject.org oror www.humantraffickingED.comwww.humantraffickingED.com
Editor's Notes
- For the 3rd goal, explain that the learners’ approach to trafficking should be like that of the one toward intimate partner violence, with the emergent medical issue as a symptom and trafficking as the disease that requires treatment.
- Explain that “trafficker” is sometimes referred to as the “controller.”
- “The larger fonts refer to types of trafficking endemic to the US; explain that: bride trafficking is when US ♂ “send away” for brides from other nations; these ♀ may not speak English or know their rights in the US & may present very similarly to an IPV victim any sexual exploitation of a minor is human trafficking by law”
- “6000,000 – 800,000 people are trafficked annually, worldwide 3rd largest illegal industry in the world, after drugs and weapons ♂ present too, esp in forced labor situations ~200,000 US children are at risk every year”
- Remind that medically we treat the symptom(s), but how we discharge speaks to what we believe about the disease; more about this later.
- “Re: distrust: Consider Jill’s story Previous bad encounters w/institutions that are supposed to help them Lies protect the little safety they have left; they are not lying bc they like their situation Interpreter is often the trafficker “one shot:” how likely is it that they will present again? IPV vs. HT: next slide will help make this difference clearer” Explain that these difficulties should not be overstated or sensationalized; identification happens—it is not uncommon at all.
- “Lack of knowledge can be picked up on mini-mental exam (just takes one question to give you a clue) Doesn’t speak, though it is clear they understand English Inconsistent story: reword their story and see if they correct you”
- “2. You are there to help & you care about them; you are not the police & you won’t call the police” -explain about police corruption -who to call in the next slide “3. Get the trafficker to leave the room under the guise of a private medical exam (which every pt. has a right to anyway). Or take their attention away from the pt. (ask them to reach for something and mouth to the patient (w/no sound), or subtle card slipping/find some medical reason to give your phone number (be careful, as the pts possession of a card w/o the knowledge of the trafficker at the time of receipt, endangers the pt’s life). 4. Pay attention to social dynamics 5. Street terms build trust 6. Bc they don’t know the term doesn’t mean they are not a victim remember: prod, reword, pay attention the details: if you’re confused about chronology, they may be lying. Don’t gasp or express shock or pity. This helps if they want to press charges later &/or gives a future provider a heads up.”
- Have learners repeat, together, the English #, 3x; they can call other lines directly too.
- “Put the victim on the phone after you briefly explain who this person is (English line is Tina, a survivor; the other lines are survivors who speak Korean or Spanish) & what services they provide (e.g.: free shelter, clothes, healthcare, no deportation, etc)” Randomly choose 3 people: ask them each for the # to the English hotline (while this slide is up)
- Only applies to sexually trafficked victims.
- You can use your email and/or mine (if it’s mine, pls title the email: “human trafficking info request”).