Nurses are uniquely positioned on the front line between a victim's health and welfare or a life of despair. An injury or medical emergency may be the only opportunity a victim of human trafficking may have to make contact with a social system that can help rescue them. The situation is even worse for immigrants. This article focuses on the hidden signs to look for and what actions can be taken.
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"Are you sure about how this happened?" asked the emergency room nurse, with a touch of impatience in her voice. "It looks like a gunshot wound." "Nah, yeah, it was a rock or something. I was mowing and a rock got spit out of the mower and it hit me in the leg. It's shrapnel from the lawnmower. I'm sure it was a rock." The nurse left the consultation room with an incredulous look, snapping the door shut behind her.
It was clear the young male patient was feeling an adrenaline rush as he fidgeted on the examination table, staring at his leg dressing. He couldn't help but prattle on erratically, as if the stranger on the examination table next to him were his best friend. "I know who it was. I know who did it. I recognized the car when it drove by. Ah man, I know why, too. I'm gonna make this right."
A few minutes later the nurse returned to inform the injured patient that both the doctor and a sheriff's deputy would soon be in to see him. "You have to realize we are required to report any suspicious activity," insisted the nurse. "If we don't report possible gunshot wounds, we get into trouble. Now let's look at that wound..."
This is a true story, and perhaps a familiar one in emergency rooms across the nation. Safety procedures and reporting systems are set up to protect victims of violence and crime once they engage with healthcare providers. A visit to the doctor or the emergency room may be the only chance a victim has for intervention.
The nurse in this instance recognized the signs of gun violence, but is she competent to recognize the hidden signs of human trafficking? Anyone can be vulnerable to this insidious crime, even in the United States, and especially among immigrant populations. Nurses are on the front line of intervention so it's important to understand how to interpret the seemingly harmless behavioral cues that hide a harsh reality that enslaves an estimated 21 million world-wide victims each year, according to the Polaris Project.
Hidden Signs
As a front line healthcare professional, would you recognize the hidden signs of human slavery? More specifically, could you identify these victims from among the non-English speaking immigrants seeking emergency treatment? The emergency room is the critical space where victims interact with the healthcare system, and may be their only chance of receiving assistance.
Look for the following indicators
Patients accompanied by someone unrelated to them who speaks on their behalf and/or controls their official documents, and whom the patients give unusual deference. Patients without money, valuables or in the case of hospital internment, any of the personal items that typically surround inpatients like cards, gifts, pictures or favorite objects from home
Physical signs of abuse, branding scars, or gang tattoos
The inability to converse with the patient in private
In these cases, verify your suspicions by asking the following questions yourself, or with the help of an interpreter:
Ask if they know how to get around the city or town where they live. If they are unfamiliar with the local areas, they may not be in control of their own movements.
Ask where they like to shop or dine out. They may not be allowed to handle money or shop anywhere but their company store.
Ask about their employer. Does he or she provide housing, food, clothes or uniforms? Do they have the freedom to seek employment elsewhere?
If appropriate, ask if they are engaging in dangerous sexual practices. If they are sex slaves, they may be following safe habits or they may be exposed to risky behaviors.
Take Action
If your suspicions are confirmed, contact the authorities to investigate your patient's situation. It's better not to ask if they are in the U.S. illegally; they may fear deportation more than they fear their abusers. Or their abusers may have threatened the safety of their family members left behind. Nor should you interrogate the patient's custodian and risk tipping your hand. Many local, county and state law enforcement agencies have been specially trained to handle cases of human slavery.
The Department of Health and Human Services offers concise recommendations in a flyer. To protect immigrant victims, a better solution is to merge human trafficking information with diversity training for the medical professions. For nurses working in areas with a significant Hispanic community, cultural competency training should address every aspect of healthcare affecting the 19 million foreign-born Latino immigrants in the U.S.
