One of the goals of Relentless is to engage health care professionals around the world to unite and mobilize against modern day slavery. Why is this important and how can it be done? This is a brief overview of the intersection between health and human trafficking. 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 be in touch if you would like more information about how you can help.
Human Trafficking is a health care issue
Although human trafficking has been recognized as a health issue for quite a long time (1) the health care sector has largely 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).
The intersection between health and human trafficking is wide and covers many aspects of health care including public health, 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.
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).
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 exist (7) (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.
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 different global 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.
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!
Katherine Welch, M.D.
REFERENCES
- Beyrer, C. Is Human Trafficking a Health Issue? THE LANCET. Vol 363, 14 Feb 2004 p.564.
- Barrows, J, Finger, R. Human Trafficking and the Healthcare Professional. South Med J. 2008; 101(5): 521-524.
- O’Callaghan MG. The Health Care Professional as a Modern Abolitionist Perm J 2012 Spring;16(2):67-69
- Caring for Trafficked Persons, Guidelines for Health Care Professionals. IOM. Geneva. 2009. https://publications.iom.int/system/files/pdf/ct_handbook.pdf
- 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
- 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
- Grace AM. Educating Health Care Professionals on Human Trafficking. Pediatr Emer Care 2014;30: 856–861
- 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
- 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
- MOVING UPSTREAM: THE MERITS OF A PUBLIC HEALTH LAW APPROACH TO HUMAN TRAFFICKING Jonathan Todres. 89 N.C. L. REV. 447 (2011)
- 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.
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