Industry combats modern slavery
Hospitals train workers to spot signs of human trafficking
From the moment she arrived in the emergency department of the Texas Medical Center hospital, the red flags were unmistakable.
The young woman had a broken finger and bruises. She was scared and uncommunicative. And she was accompanied by a middle-aged man who clearly didn’t want her answering questions without him.
Prodded after forensic nurses finally got her alone, the woman confirmed what the team had suspected: she’d been assaulted for her resistance to engaging in an act of prostitution.
The team alertly picked up on the signals thanks to training they’d recently received in human trafficking, which involves the use of force, fraud or coercion to compel a person into commercial sex acts or labor against his or her will. The new push in the medical center and in health care institutions around the nation is based on the premise that interventions in such settings can represent a lifeline to victims.
“Health care providers have a unique opportunity,” says Kimberly Williams, a Baylor St. Luke’s administrator who heads the medical center’s human trafficking consortium. “Recognize the warning signs, separate the patients from the perpetrators, and we can get them out of slavery and onto the road to freedom and recovery.”
The training comes as the numbers continue to grow. There
are now nearly 50 million people trapped in modern-day slavery, according to the International Labor Organization, and the U.S. Justice Department estimates that as many as 17,500 slaves are brought into the country every year. Worldwide, the industry generates an estimated $33.9 billion a year, according to the ILA.
Identifying the signs
The issue is particularly acute in Houston and Texas, which experts attribute to its proximity to Mexico, major interstate highways and the port. The state ranks second only to California in the number of victims, and Houston has more than any other city, according to a University of Texas study. The study estimated some 313,000 Texans are victims of labor and sex trafficking.
Some are young children. Dr. Reena Isaac, medical director of the forensic nurse team at Texas Children’s Hospital, said they’ve identified trafficking victims as young as four and that most are 12 to 16.
Health care institutions have a role to play because trafficking’s victims so often require medical treatment. A 2014 Annals of Health Law survey of human trafficking survivors found that some 88 percent saw a health care provider at some point during captivity.
The problem was few providers recognized the signs — or knew how to intervene.
“Health care providers of all kinds — in emergency wards, health care clinics and private practices — are seeing trafficking victims but failing to identify them, thereby unwittingly contributing to continuing criminal activity and exacerbating both public and private physical and mental health problems for this segment of the population,” Laura Lederer and Christopher Wetzel wrote in the Annals of Health Law paper.
Experts say the missed signs include untreated chronic conditions, uncertainty about the city they’re in, a fearful and/or submissive demeanor often including avoidance of eye contact, malnutrition or signs of physical abuse or trauma, and a controlling companion who insists on answering questions.
Trafficking awareness
Hospital employees’ unfamiliarity with the signs led Melissa Graham, a nurse at Houston Methodist Hospital, to spearhead a trafficking awareness and intervention campaign. The result is the medical center’s newest policy, which involves training in the telltale signs and the procedures to follow if trafficking is suspected.
Graham was motivated by her own family experience: a niece lured into the world of trafficking at 18 years of age. Kidnapped from an Indiana mall during a visit with a man she’d met online, Graham said her niece was forced to work as a prostitute for six months before the FBI rescued her in Oregon about 5 1/2 years ago.
“She doesn’t talk about it much, but it’s clear it was rough — she got one meal a day, had her hair dipped into bleach to change its color,” says Graham. “She was taken from Indianapolis to Oregon and was about to be shipped out of the country. It was an ordeal she’s still working through.”
Hospitals now benefit from new diagnosis codes — Catholic Health Initiatives, owner of Baylor St. Luke’s, led the campaign for them — that differentiate trafficking from other types of abuse. The codes, rolled out in October, will help track the number of victims and provide appropriate treatment.
Methodist hasn’t yet identified and treated a victim, but it’s a different story at Ben Taub Hospital, where an anti-trafficking program has been in place for more than a year now.
In the first year, the safety-net hospital assessed 124 suspected labor and sex trafficking victims who were identified by staffers there or by hospitals or clinics or shelters in the area that then referred them to Ben Taub. Some couldn’t be assessed because the patient would not submit to an interview, but 76 were confirmed to be victims of trafficking.
“The problem was that, prior to the program, employees weren’t asking basic questions that could have identified victims,” said Dr. Asim Shah, Ben Taub’s chief of psychiatry. “Because there is such a perception that victims are immigrants or are kidnapped in other countries, people are surprised so many local people are affected.”
The program is funded by a number of grants, one from the office of Gov. Greg Abbott, who this year unveiled initiatives to increase penalties for human traffickers and to create regional squads to combat trafficking. Some states have gone further — Florida and Michigan, for instance, recently passed laws requiring that health care workers receive human trafficking training as part of their regular licensing process.
Still, Texas Medical Center efforts are already paying off. The woman assaulted for resisting prostitution is now out of the life and off drugs that her perpetrators used to control her thanks to the hospital’s intervention.
Shah says all the Ben Taub patients confirmed to be victims of trafficking accepted basic treatment and half of them returned for outpatient psychiatric appointments after discharge.
“Just getting them in treatment is a success,” Shah said. “That half of them return for treatment is a huge success.”