Human Trafficking:
Clinical Presentation
&
Treatment
How to Care for
Trafficked Persons in the
E.D.
Makini Chisolm-Straker, MSIV
Brown Medical School, Mt. Sinai School of Medicine
2008
Instructional Goals:
• You will be familiar with the clinical presentation of
human trafficking victims in the E.D. in the U.S.
• You will be familiar with the appropriate treatment of
human trafficking victims.
• You will appreciate the role of emergency healthcare
practitioners in facilitating the escape of trafficked
persons.
Instructional Learning Objective
(what you will do by the end of this session):
You will know the hotline to call when
a suspected trafficking victim
presents to the emergency
department.
Case
• obtunded teenage ♀, GCS 5
• extensive bleeding from vaginal canal
• visible burns, cuts, scars on wrists,
ankles, neck
• h/o schizophrenia?
• bro. concerned about a dangerous
abortion attempt
Human Trafficking is:
• the recruitment, transportation, transfer, harboring
or receipt of persons:
– by the threat or use of kidnapping, force, fraud,
deception or coercion, or by the giving or receiving
of unlawful payments or benefits
– to achieve the consent of a person having control
over another person, and
– for the purpose of sexual exploitation or forced
labor.
Human Trafficking is:
• the illegal use of a variety of means
• to force an individual (the trafficked)
• to relinquish his/her personal freedom
• for the profit of another person (the
trafficker).
• often, simply considered “involuntary
servitude” or “modern-day slavery.”
Types of Trafficking
Sexual Exploitation
• prostitution
• pornography
• bride trafficking
• commercial abuse of children
• massage parlors, hostess clubs, brothels,
escort services, commercial phone sex &
internet dating
• exotic dancing/stripping
Types of Trafficking
Forced Labor
• domestic servitude (domestic work & child
care)
• manual labor
-small-scale factory work
-construction work
-sweatshops & farms of multinational corps
-agricultural & landscape work
• restaurants
• nail salons
• hotel housekeeping
•
•
•
•
•
•
false adoption
drug trade
street begging
camel jockeys
child soldiers
organ harvesting
Trafficking Affects
(Populations at Risk):
•15,000 – 60,000 people are trafficked into the
U.S. annually
•80% of trafficked persons are ♀ & children
•U.S. citizens
•U.S. residents
•documented immigrants
•undocumented immigrants
•youth (esp. runaways)
•urban pop.
•suburban pop.
Role of Healthcare Practitioners
in the E.D.
• Identify human trafficking victims
• Treat the chief complaint/illness and/or the
emergent issue
• Offer (& provide, if patient-desired) appropriate
treatment for the unsafe environment
Difficulty Identifying Trafficking Victims
• distrust of service providers
• lies & false stories
• untrustworthy interpreters
• “one shot”
• difference between intimate partner violence &
human trafficking
Signs & Sx
•
•
•
•
•
•
•
•
lack of knowledge of a given community/whereabouts
not in control of personal ID
few  no personal possessions
does not speak
3rd party insists on being present or interpreting
injuries (multiple, old & new)
signs of malnourishment
branding
Signs & Sx
•
•
•
•
•
•
•
•
no healthcare
under 18 & in sex industry – DE FACTO
claim of “just visiting”
inconsistent story
behavior change when “law enforcement” is mentioned
STIs
bacterial &/or yeast infxns
demeanor (e.g.: fearful, anxious, submissive, flat affect)
What to do
What to do
1.
2.
3.
4.
5.
6.
7.
building trust is the number one priority
reassure the potential victim
one-on-one interactions are ideal
specifically ask about the patient’s safety
offer reworded stories
stay calm & even-keel
ALWAYS document your suspicion in your
notes, at the very least
8. Call a Help Hotline:
English: 1-888-373-7888
Korean: 1-888-976-5274
Spanish: 1-888-80-AYUDA
The folks working at the hotlines are trained to know
how to help you, but you are their eyes & ears.
Trust their knowledge, your experience & your gut.
If the patient is an adult, they have the last say, but
give them every opportunity to receive help.
Even if a potential victim doesn’t want help,
call:
1 - 8 8 8 - 3 7 3 - 7 8 8 8,
to report suspected trafficking;
the tip can save lives.
Clinical Recommendations*
Presumptive Treatment for:
• gonorrhea
• chlamydia
• trichomoniasis
• syphilis
• UTI
*for sexually exploited victims
Special thanks to Polaris Project
for the images & information.
Clinical Recommendations courtesy of
Doctors of the World.
For more information on
trafficking in the U.S.
you can:
email: m.chisolmstraker@gmail.com
visit: www.polarisproject.org
or
www.humantraffickingED.com