Jessica only wanted heroin detox, told us not to worry about her arm wounds. She was in police custody, and the officer who escorted her told us she’d been sleeping on the streets, picked up for an old warrant. We hospitalized her for osteomyelitis that was likely to result in amputations of both forearms. Despite a constant police presence during her stay, her trafficker made numerous attempts to visit her. She was ultimately lost back to the streets, and presumably back to her trafficker, during an unsupervised transport between facilities.
Human trafficking is an emerging criminal, social, and public health problem in the U.S. and abroad. Human trafficking encompasses any activity related to the coercive or deceptive exploitation of individuals, most commonly sexual or labor exploitation, for the gain of the trafficker(s). Human trafficking does NOT require physical transport. Human trafficking cases in the healthcare system, like the cases above, are upsetting, unsatisfying, and incomplete. There is incomplete information, as trafficked patients often leave before completing their care. There is uncertainty in identifying whether someone is being trafficked, even when there is strong suspicion or clear evidence. The visits may be distressing to providers, who want to help but must ultimately allow the patient the freedom to decline social services or other interventions, even after patients have disclosed they are being trafficked.
Human trafficking poses a unique challenge for EM clinicians, who are often the only providers who see these patients while they are being trafficked. We have limited time to build the rapport and trust necessary to overcome patient’s fear and apprehension. We lack effective screening tools and guidelines that are specific enough to accurately identify trafficked persons, and sensitive enough not to miss those with more experienced and system-savvy traffickers. We have limited resources for adequately exploring the cases we identify as likely trafficking. We also know that pursuing trafficking cases or even identifying a person as a victim of trafficking may actually be more harmful than beneficial, and as such requires individualized responses for each patient. Premature identification of a trafficked patient, without a multidisciplinary team, may cause psychological harms like anxiety and retraumatization as well as critical safety risks as patients may be subject to physical, emotional, and sexual retaliation if they return to a trafficker.
While this is a helpful start, many of us working in urban or safety net emergency departments recognize that a significant majority of our patients would meet at least one, if not many, of these criteria.
United States Department of State. Trafficking in persons report. June 2016. http://www.state.gov/j/tip.