The Physician Advocate

Identifying and Intervening in Cases of Trafficking

By Dr. Kimberly Kirkland, Associate Dean of Student Affairs

It is always an honor to attend the Academy of Women's Health Annual Congress and this year was no different, particularly given the time devoted to advocacy around women’s health issues. For me, the most startling and informative presentation was Sex Trafficking of Women and Girls: Even in Your Community by Suzanne Harrison, MD, who is a professor and family medicine educator at Florida State University College of Medicine.

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Left to right: Dean Julie Taylor with AUC students Sasha Vartanov, Daniel Namkoong, Lissette Moreno, Aditi Kalotra and Dean Kimberly Kirkland at the 2017 Congress on Women's Health in Washington, DC.

Dr. Harrison devotes a large portion of her time battling sex trafficking in Florida and throughout the United States. In addition to providing outreach to survivors, she educates physicians and allied health professionals on how to recognize clinical signs that may indicate a patient who is being enslaved or trafficked. Although it's an uncomfortable topic for many, it is extremely important for physicians and other healthcare providers to be aware of this problem as they are often on the front lines of interaction and can help intervene.

Almost 21 million people are living in slavery worldwide and while it’s difficult to estimate how many are being held in the U.S., more than 2,000 survivors of trafficking were identified in this country in 2016. Many of them were saved by the keen eye of their healthcare providers. 

Risk factors for trafficking include recent migration or relocation, substance use, runaway or homeless youth, mental health difficulties, and unstable housing. A recent study by the National Center for Missing and Exploited Children found that 1 in 6 adolescent runaways had been victims of sex trafficking.   

Dr. Harrison explained that trafficking victims often present in emergency departments and urgent care facilities; primary care facilities including pediatrics, family medicine, and internal medicine; women’s health clinics; health departments; and dentists' offices. Physicians should look for the following warning signs: adolescents and adults being accompanied by a “controlling person” who answers questions asked of the patient or who interrupts or corrects the patient and controls the patient’s identification documents.

In addition, patients may exhibit fear, nervousness, and avoid eye contact. He or she may seem hyper-vigilant and/or subordinate in demeanor. The patient may also present with unusual injuries, signs of physical trauma, unusual infections, multiple STDs, and/or several somatic symptoms arising from stress. Other red flags include an inconsistent or scripted-sounding story, a discrepancy between the story and what is observed by the physician, an appearance much younger than the patient's stated age, inability to give an address or current city, seasonally or situationally-inappropriate clothing, and/or carrying large amounts of cash. 
 
If a physician suspects a patient is being trafficked, Dr. Harrison recommends trying to separate the patient from the controlling person. However, she cautions that if the patient cannot be interviewed privately, do not ask any questions that might put the patient at risk for injury or death following the doctor’s visit. During the private evaluation, maintain confidentiality and provide frequent reassurance. Avoid pressuring the patient to disclose and let the patient feel in control of the interview, examination, and outcome. Make the patient aware of his or her legal rights. 
 
Dr. Harrison closed with the reminder that the physician is not a service provider for human trafficking but is rather a link to services available. Physicians may provide patients they suspect may be being trafficked with the National Human Trafficking Resource Center hotline number: 888-3737-888. Physicians should also follow their institutional protocols for abuse, unless a specific protocol is in place; if the patient is a minor, the physician must follow state mandated reporting laws for child abuse.
 
More information about human trafficking and ways to help may be found through these national agencies: