Case Study: Clinical Consideration Part 2
Continuing Jessica’s visit, you are now beginning her physical examination. Mark indicates he would like to remain in the room during the examination, Jessica agrees and consents to his presence. He stands next to the head of the bed during the pelvic examination. Upon completion, you have identified an outbreak of Genital Herpes, and microscopic examination of the discharge reveals Trichomoniasis, two sexually transmitted diseases. Mark seems unusually undisturbed by the diagnoses. You are concerned about Jessica’s current living situation and would like to question her privately. In discussing the diagnoses with Jessica and Mark, you indicate that she must undergo urine pregnancy testing before beginning treatment and request that she accompany you to the restroom to provide a urine sample. Mark offers to go with her and wait outside of the restroom. You explain that it is not possible as the route to the restroom may pass other patients’ rooms, that the restroom is in a location shared with other patients, and you must protect their privacy. Mark quickly replies that it is impossible for Jessica to be pregnant, as she is compliant with her oral contraceptives, her periods are normal and questions the necessity of the test. You indicate she will not be treated until the test is complete, and Mark reluctantly agrees. You lead Jessica to a private conference room and emphasize that everything the two of you discuss will remain confidential. You preface your questions by stating, “I am worried about you, and would like to ask some questions about your current living conditions and situation so that I might help you.”
1. Take a moment to consider how you might respond if Jessica refuses to answer any further questions.
2. Take a moment to consider ways you could help Jessica if she did indeed admit to being a victim of human trafficking.
Domestic as well as international victims of human trafficking have specific legal rights under federal and state law, but may not know of these rights or be in a position to exercise them. If the patient is willing, a referral to law enforcement, attorneys, or legal service providers is appropriate. Conclusion Clinicians, as “first contacts,” have an imperative to make a difference for their patients. Human trafficking poses many health risks, including physical injury, death, and/or long-lasting psychological damage. In the absence of validated tools to screen for victims of human trafficking, health care providers may need to consider implementing universal methods and policies to create a safe environment for all patients. Clinicians who encounter a trafficked person or other exploited individual have a unique opportunity to provide essential medical care and supportive referral options that may be an individual’s first step towards safety and recovery. Texas Resources
National Resources
Coalition Against Trafficking in Women www.catwinternational.org
Human Rights Watch www.hrw.org
SOAR to Health and Wellness acf.hhs.gov/endtrafficking/initiatives/soar
HEAL Trafficking https://healtrafficking.org
Caring for Trafficked Persons: A Guide for Health Providers http://publications.iom.int/books/caring-trafficked- persons-guidance-health-providers National Human Trafficking Resource Center (NHTRC)
Hotline (24/7): 1-888-373-7888 http://traffickingresourcecenter.org/
Polaris Project www.polarisproject.org
Texas Office of the Attorney General humantrafficking@oag.texas.gov 512-463-1646
Texas Child Protective Services 800-252-5400
Texas Department of Public Safety, Victim Services 512-424-2211 dps.texas.gov/administration/staff_support/ victimservices/pages/index.htm
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