The inaugural edition of The Doctor is IN webinar discussed the broad overview of the intersections between health and human trafficking. This is the corresponding blog post to that video recorded 20 July 2020. Sign up for the newsletter or stay tuned on the Relentless Facebook page for the link to join the next installment. Webinar episode #3 will be about the links between adverse childhood experiences and human trafficking.

As a big-picture person it is helpful for me, and perhaps also for you, to start at the top for an overview of the many ways that health, healthcare, and naturally the professionals therein, intersect with the fight against human trafficking.

Most people probably automatically think, as when I first started in counter-trafficking work, that the way healthcare professionals can best work against human trafficking was to treat survivors with care. I had not yet heard about trauma-informed care in 2000 but it was obvious that an extra care was necessary to help them heal, even if at that time I didn’t understand all the neuro-bio-psycho-physiological connections that I do today. However, it didn’t take long before I discovered that the work goes much deeper than good clinical care.

We need to broaden our idea of counter-trafficking work beyond law enforcement, legal issues, immigration, and justice departments. We need to broaden our idea of counter-trafficking work beyond rescue and recovery. We need to broaden our idea of justice beyond nabbing the bad guys and criminal deterrence. Access to justice means access to all determinants of social well-being. That includes health care. Slavery is a law enforcement, immigration, and social issue, but it is also much more than that. It is also a health care issue. This is the lens through which I see things and hope to bring this perspective to the table on a global level.

Although human trafficking has been recognized as a health issue for quite a long time,1 the health care sector has largely been overlooked its role in countering slavery and exploitation today. Although healthcare professionals may know about this issue in general, most are unaware of how they can leverage their specific skills against it. Physicians, nurses, dentists and other health care professionals have a unique and important role to play.2,3 We can make this issue relevant to health professionals and they need an invitation.

The intersection between health and human trafficking is wide and covers many aspects of health care including public health, prevention, research, advocacy, and clinical care. An excellent starting resource for health practitioners is the book Caring for Trafficked Persons, Guidelines for Health Care Professionals.4 It is designed as a general guidebook for health professionals globally and has been translated into several languages.

One of the goals of Relentless is to engage health care professionals around the world to unite and mobilize against modern day slavery. Another goal is to get counter-trafficking organizations to realize the great resources that healthcare professionals can bring to the work against slavery. We are not just technical people to help fix physical or mental health problems – of course we need to be good at that! But we also bring a different perspective and different ways of approaching problems. Health care providers are clinicians, educators, advocates, and researchers and therefore we bring a wide variety of skills to this movement. We need everyone in every sector to be engaged collaboratively. Here I’ll highlight several aspects including trauma-informed care, prevention, research, organ trafficking, and advocacy. Throughout this series I’ll be addressing these and many more topics in more depth.

Trauma informed care: Providing great clinical care can be quite a challenge if the physician is not aware of the complexities and co-morbidities associated with chronic trauma. Because trauma induces psychological as well as physiological pathologies, patients often have symptoms that don’t fit a particular syndrome and don’t necessarily respond to the typical treatments. This can frustrate physicians who have a one-sided somatic approach to illness.5

Furthermore, it is simply not enough for health professionals to simply provide competent clinical care to survivors; the care must be also trauma informed. Trauma informed care is given in a way that recognizes that an individual likely suffers from trauma and creates a safe place for both provider and patient to work. Unfortunately, I’ve sometimes learned the hard way about what it means to be a good doctor to them. An excellent resource to learn more about trauma informed care is the Substance Abuse and Mental Health Services Administration.6

Every encounter with a survivor can be a step in their healing process, or not. It is important to realize that health care professionals can inadvertently re-traumatize their patients. There are several ways this can happen and unfortunately it is easier to do than you would think – I know because I have made some egregious errors myself and have learned from my mistakes.

Identification: Healthcare professionals are on the “front lines” of human trafficking in that we are in one of the sectors with whom trafficked people may interact. In fact, a relatively high number of trafficking survivors report that they saw a health professional during the time they were trafficked, and these are missed opportunities to help them. They may be visiting an urgent care clinic, a crisis pregnancy center, or have had an accident at work. Many articles and training opportunities exist7 (and many more since that publication) to help equip health care professionals to learn how to identify someone and make a safe referral. Organ trafficking is a form of human trafficking that is germane to medicine, and yet the health care system is silently complicit with the organ trade.8 We can do much more within our profession to stop this egregious crime.

Overview Outline

  • Trauma-informed care of survivors
    • Understanding of the nuances of caring for the chronically traumatized
    • Survivors have complex healthcare problems.
    • Good doctors can re-traumatize if they don’t understand the mental health complexities. This is what I want to avoid.
  • Organ trafficking
    • An issue germane to hospitals and healthcare
    • Hospitals, clinics, and professionals therein are complicit in this trade. Not just the people buying and selling the organs. Some doctors are active in the trade. Many others take a “don’t ask, don’t tell approach” and are thereby passively complicit.
  • Access to & Identification & Referral
    • Many trafficked people see health care professionals – front lines
    • Must know red flags and signs someone is in trouble
    • Then we must also know how to make safe referrals, build and maintain trust with the survivor
  • Prevention
    • Human trafficking can be prevented! We can reduce vulnerabilities!
    • Preventing child abuse and neglect (reducing ACEs)
    • Preventing exorbitant medical bills forcing families into deep debt
    • Public health approach to prevention promoted beyond health care sector
  • Research
    • Evidence-based medicine
    • Research of the particular problems, forms of trafficking, mental health in specific cultural and regional contexts
    • Most research in N. America, but also assumes a N. American healthcare model, which of course doesn’t apply anywhere else.
  • Advocacy
    • Social credibility of healthcare professionals
    • For robust prevention-focused policies to support families, assistance for children at risk, keeping children in school, etc.
    • Survivor access to continuity of care, payment of care, mental health care, etc.

Prevention: Human trafficking can be prevented. Applying the principles of public health to address human trafficking provides a very comprehensive approach to prevention.9,10 It is well-known that adverse childhood experiences (ACEs), are a huge public health problem and create vulnerabilities and conditions in victims so that these children have increased risk of being trafficked.11 Stopping child abuse and neglect will decrease many chronic health problems as well as reduce human trafficking. Another way to reduce the risk of human trafficking is to address outrageous medical debt that sends families into crisis and looking for extreme ways to generate income. Advocating against practices such as child marriage, voluntourism, and promoting greater transparency in adoption practices are other ways to protect children from being trafficked.

Research: Much more research is needed to be able to better able understand the health consequences of human trafficking as well as improve the evidence-based care of survivors. The research needs to be done across various sectors of human trafficking as well as in the different geographical regions in order to better specificity the identification methods as well as treatment best practices.

Awareness and Advocacy: Many scholarly articles about the physical and mental health needs of trafficking survivors have been published in academic journals in Europe and elsewhere. However, this sector remains small and obscure – and the gap is widest in lower income countries where the need is even greater. It is necessary to tap into the deep well of health professionals who do not know about this issue, why it is important for them to care, or what they can do about it. Health professionals are great advocates for health care rights of survivors and the special needs they have. When hospitals and clinics are aware of the vulnerabilities of trafficking victims and survivors, they can be more proactive to decrease the size and number of gaps in care. Referrals are facilitated more rapidly, continuity of care is improved, and multidisciplinary encounters are encouraged.

There are a wide variety resources available for health professionals as well as the public to learn more about all the aspects of how the health care sector can counter human trafficking. Please visit my website or be in touch with me if you would like more information about how you can help.

Healthcare professionals have a unique and important role to play to counter human trafficking. When we are united in a movement against human trafficking then we will be empowered and phenomenally effective to prevent human trafficking, interrupt its destruction, and care for those affected. Please join the movement! I wouldn’t be in this work if I didn’t think I was making a difference. I think everyone can make a difference!

REFERENCES

  1. Beyrer, C. Is Human Trafficking a Health Issue? THE LANCET. Vol 363, 14 Feb 2004 p.564.
  2. Barrows, J, Finger, R. Human Trafficking and the Healthcare Professional. South Med J. 2008; 101(5): 521-524.
  3. O’Callaghan MG. The Health Care Professional as a Modern Abolitionist Perm J 2012 Spring;16(2):67-69
  4. Caring for Trafficked Persons, Guidelines for Health Care Professionals. IOM. Geneva. 2009. https://publications.iom.int/system/files/pdf/ct_handbook.pdf
  5. Raja S, et al. Trauma Informed Care in Medicine Current Knowledge and Future Research Directions. Fam Community Health. Vol. 38, No. 3, pp. 216–226
  6. SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. SAMHSA’s Trauma and Justice Strategic Initiative. July 2014 https://ncsacw.samhsa.gov/userfiles/files/SAMHSA_Trauma.pdf
  7. Grace AM. Educating Health Care Professionals on Human Trafficking. Pediatr Emer Care 2014;30: 856–861
  8. Ambagtsheer F, Van Balen L. ‘I’m not Sherlock Holmes’: Suspicions, secrecy and silence of transplant professionals in the human organ trade. Eur J Crim. 1–20. DOI: 10.1177/1477370818825331
  9. J. Greenbaum et al. Multi-level prevention of human trafficking: The role of health care professionals Preventive Medicine 114 (2018) 164–167 https://doi.org/10.1016/j.ypmed.2018.07.006
  10. MOVING UPSTREAM: THE MERITS OF A PUBLIC HEALTH LAW APPROACH TO HUMAN TRAFFICKING Jonathan Todres. 89 N.C. L. REV. 447 (2011)
  11. Felitti VJ. Childhood trauma linked to chronic diseases in adulthood: implications on the medical and economic burden of human trafficking. Public Health and Social Justice. Vol. 2, (1) Summer 2013.