● Skin or respiratory problems caused by exposure to agricultural or other chemicals ● Infectious diseases, such as tuberculosis and hepatitis, that are spread in overcrowded, unsanitary environments with limited ventilation ● Reproductive health problems, including sexually transmitted infections, urinary tract infections, pelvic pain, and injuries from sexual assault or forced abortions and to offer additional resources when appropriate. It is not the responsibility of healthcare providers to elicit/coerce a disclosure of human trafficking or to investigate/confirm human trafficking. The responsibility of healthcare providers is to provide patient-centered care; to empower victims to seek additional support when appropriate; and above all, to respect the autonomy of the patient. 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. documentation, reporting, intervention, and referral and may be incorporated into existing protocols for interacting with potential victims of child abuse, violence, and/or sexual assault. A study by Zimmerman et al. (2006) found that survivors of human trafficking reported the following symptoms of anxiety and depression: Nervousness or shakiness inside (91%), terror/panic spells (61%), fearfulness (85%), feeling depressed or very sad (95%), and hopelessness about the future (76%). ● Victims may display obvious sexual health concerns such as risky sexual behavior (having multiple partners), repetitive and frequent STI screenings, frequent visits for reproductive healthcare and/or abortions, and signs of sexual trauma. ● Other potentially obvious red flags include a delay between injury/illness onset and seeking care or concerning prescription filling patterns. By taking a more nuanced history about the presenting complaint, along with a brief social history assessing home and work environments, providers may be able to discern a potential trafficking situation. Carefully reviewing medical records is essential and an effective way to supplement or clarify a patient-reported history when it is vague, misleading, or untrue. A study of sex- trafficking survivors from two major U.S. cities revealed that most participants who took part in the study reported visiting the same healthcare clinic on several different occasions for various injuries (Richie-Zavaleta et al., 2021). The authors use this to highlight the importance of reviewing patients’ medical records when identifying patients who may be victims of human trafficking. Additional red flags may be seen in a victim’s companion/ guest and include behaviors such as refusal to leave when
● Symptoms of PTSD, phobias, panic attacks, anxiety, and depression ● Sleep or eating disorders ● Untreated chronic illnesses, such as diabetes or cardiovascular disease ● Signs of physical abuse, such as bruises, broken bones, burns, and scarring ● Chronic back, visual, or hearing problems from work in agriculture, construction, or manufacturing The role of healthcare providers As previously mentioned, healthcare providers have a unique position and ability to identify, assess, and respond on behalf of trafficking victims. The primary focus of any interaction with a potential or known victim of human trafficking should be to address the chief complaint (acute illness or injury), establish healthcare facilities and providers as allies and safeguards from trauma and/or exploitation, Case study 1 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, Organizational protocols Whenever possible, facilities should create trauma-informed organizational protocols to ensure that human trafficking survivors receive the best possible care. These protocols should include guidelines for appropriate assessment, Identification and assessment Identification Many victims of human trafficking are not willing to disclose the nature of their situation due to trauma and fear stemming from oppressive conditions and lived experiences. However, many victims and traffickers exhibit signs that can be identified. Potential red flags indicating a patient is a victim of human trafficking may be exhibited by both the patient and the patient’s guest/companion. Some potential patient-specific red flags include repeated physical injuries and signs of physical abuse/neglect, sexual health concerns with repetitive STI screenings or reproductive care, body language, and delayed care (Richie- Zavalet et al., 2021; Stocklosa et al., 2022; Tiller & Reynolds, 2020): ● A victim’s body language may convey that they are fearful, hypervigilant, and anxious. Victims may avoid eye contact with providers, may appear disoriented, may be unable to recall or report basic information such as their address, and may even be unable to produce identification documents. ● Victims may present with frequent and repeated injuries or other signs of physical abuse and may be vague/ inconsistent in their description of the injuries. Common physical injuries include broken bones (jaws, legs, arms, ribs, eye sockets, etc.), significant bruising from being hit/punched/thrown, and work-related injuries resulting from unsafe occupational conditions. ● Victims may also present with obvious mental health concerns such as generalized anxiety, major depression, dissociation, and deliberate self-injury/suicidal ideation.
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