MGH aims to help victims by listening, looking for signs
Victims of human trafficking often move through the medical system with broken bones, infections and neglected ailments, treated by doctors who are blind to the horrors behind these recurrent health troubles.
But physicians at Massachusetts General Hospital are trying to change that.
The MGH emergency department is now using a model to spot trafficking victims and intervene before their abusers can remove them from the safety of the hospital, according to Dr. Wendy Macias-Konstantopoulos, director of MGH’s Human Trafficking Initiative, established in 2007.
“At Mass. General we have a protocol in the emergency department for when patients present with signs,” Macias-Konstantopoulos said yesterday at the Herald’s roundtable on drugs and human sex trafficking. “This is not everywhere, but it needs to be everywhere.”
The most recent numbers show 88 percent of sex trafficking victims have access to health care, and 63 percent seek help through hospital emergency departments.
Doctors could be on the front lines in the fight against the trafficking epidemic. But the medical world still grapples with finding the right approach. As of yet, there has been no standard of care established for these patients.
The protocol, which Macias-Konstantopoulos helped draft in 2015, calls for emergency department employees to be trained to spot tell-tale signs rather than relying on explicit questioning.
Along with repeated sexually transmitted infections and unwanted pregnancies, some patients will show up with broken bones or wounds that were not immediately treated. There are also behavioral signs indicative of post-traumatic stress disorder, such as the tendency to startle easily.
A social worker or physician then carries out a private interview with the patient that involves subtle questions ranging from queries about average sleep schedules to how safe they feel on a regular basis.
But detection requires intuition, Macias-Konstantopoulos said, which is why extensive training is important.
“You don’t want to go straight to asking them if they’re being trafficked,” she said. “The thing that’s most important is to build that trust with the patient, build that relationship.”
She added, “It’s really hard for doctors to be in the moment, especially in ERs where it’s really busy. But it’s really important that we are in the moment, that we’re actively listening.”
Yet even then, doctors can run into barriers. The average age young women and men enter the trafficking world is 14 — making many of them victims of child abuse. But, Macias-Konstantopoulos said, if the Department of Children and Families does not deem the case worthy of investigation, it lands on the providers in the emergency department to find safe housing for the victim.
MGH is working to refine its approach as the number of abused patients soars. Macias-Konstantopoulos said it needs to be a wider effort that includes medical school training for the next generation of doctors.
“It’s still sort of an ongoing effort,” she said. “I think this is something we obviously need to work toward, but we’re not quite doing it as a system.”