Recognizing and Responding to Human Trafficking in Texas, 2nd Edition: Summary 4
CASE STUDY
A young woman named Rebecca presents to a local urgent care requesting evaluation for genital sores and vaginal discharge. You notice on her intake information that she does not have insurance listed and indicates she is paying cash for this visit. Further review of her medical records shows that she does not have a permanent address listed and that she has presented on multiple occasions to this urgent care—in addition to other clinics/healthcare facilities—with similar symptoms.
She is accompanied by a man named Derek, whom she claims to be her cousin, and who largely speaks for Rebecca, answering questions while she remains sitting quietly on the examination table. Rebecca appears nervous and avoids making eye contact with you and other staff members. She has superficial abrasions and bruises around her eyes and mouth as well as on both upper extremities. Take a moment to consider any potential red flags that you, as the healthcare provider caring for Rebecca, notice that would indicate Rebecca is a victim of human trafficking. Continuing Rebecca’s visit, you are now ready to begin her physical examination. Derek insists he would like to stay in the room during the examination, and Rebecca consents to his presence. He remains standing at the head of the bed during the pelvic examination. The exam helps you determine Rebecca’s presentation is consistent with an outbreak of genital herpes, and microscopic examination of the discharge reveals trichomoniasis. These are two sexually transmitted infections. Derek seems unusually undisturbed by the diagnoses. You are concerned about Rebecca’s current living situation and would like to question her privately. While discussing the diagnoses with Rebecca and Derek, you inform them that you would like Rebecca to have a urine pregnancy test done before beginning treatment and request that she accompany you to the restroom to provide a urine sample. Derek states he will go with her and wait outside of the restroom. You explain that this is not possible because the route to the restroom passes other patients’ rooms and that this may result in an unintentional disclosure of protected patient information. Derek quickly replies that it is impossible for Rebecca to be pregnant and insists she has been compliant with her oral contraceptives and her periods are normal. Then he begins to question the necessity of the test. You inform them that she will not be treated until the test is complete, and Derek reluctantly agrees. You lead Rebecca to a private conference room and emphasize that everything the two of you discuss will remain confidential. Before continuing, you say to Rebecca, “I have a few concerns and would like to ask you some questions about your current living conditions and situation. Would that be alright?” • What questions would you ask Rebecca to help determine if she is a victim of human trafficking? • If Rebecca discloses that she is a human trafficking victim, what are ways that you could help her? What resources would you provide Rebecca? Who else would you contact/involve in the situation? • How might you respond if Rebecca declines to make an explicit disclosure or refuses to answer any questions?
Conclusion Healthcare providers must be educated on identifying, assessing, and responding to human trafficking victims to provide necessary care and support. This education is crucial for helping victims transition to survivors.
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