SEX TRAFFICKING: A CLINICAL GUIDE FOR NURSES
By Mary de Chesnay, Editor, Springer Publishing
This book addresses a difficult reality, yet an important topic for all health care providers who may find themselves caring for patients in the hospital or community setting that may be victims of sex trafficking and at risk for significant emotional and physical harm.
This book is divided into 2 sections. Part I discusses Theoretical Perspectives with 8 chapters, and part II discusses Clinical Perspectives with 12 chapters. Before moving too quickly into the book, I would suggest that the reader first read the last paragraph of the Foreword by Georgia Senator Renee S. Unterman before proceeding to read the chapters especially the last 2 sentences:
My office is filled with photos of famous people, awards for all kinds of humanitarian deeds[horizontal ellipsis]. And in a prophetic moment, it hit me like a freight train[horizontal ellipsis] what on earth could be more important than helping just one child, just one helpless victim of the sex trade?
This book may also shock the reader with the reality that sex trafficking is one of the most lucrative global businesses. It may not be realistic to think of stopping it, but caring for survivors of the human trafficking trade can be a challenging and rewarding role for nurses. Chapter 1 "Sex Trafficking as the New Pandemic" attempts to orient the reader to the 5 stages of the process of human trafficking: vulnerability, recruitment, transportation, exploitation, and finally (if they ever get to these stages) exposure, discovery, and liberation. Entrapment is discussed including ensnaring, creating a milieu of dependence, controlling, and, the final stage, complete dominance.
Among the best practices and evidence-based research concepts mentioned in chapter 1 is primary prevention. Although primary prevention was mentioned as one of the most important concepts all health care providers need to understand, it is a different concept for victims of human trafficking. In caring for survivors of sex trafficking, primary prevention "is not only irrelevant but impossible." If primary prevention is irrelevant and impossible, discussion of secondary and tertiary levels of prevention would have been timely and helpful.
Survivors' experiences are presented using case studies. Useful intervention models are presented, with a reminder to health care providers that relapse is normal. A respect for the survivor's right to self-determination is paramount, and one may assume the first visit is the last.
Chapter 2 entitled "Human Trafficking" opens up with Tanya, a survivor of domestic minor trafficking. As a reader, I think there is clarity in consistency-the book is "Sex Trafficking[horizontal ellipsis]." Chapter 2 is on "human trafficking." It would have been fitting to make "human trafficking" the title of the book for consistency and use of the broader terminology than sex trafficking. I will remind the reader of my remarks on the name of the book later. Chapter 3 is on community models and resources. Table 3.1 may have also been captioned as "US and Global Community Models and Resources for Survivors of Human Trafficking" because it mentions resources in the United States and around the world. Chapter 4, "Working With Law Enforcement," includes suggested interview questions for determining a patient's status as a suspected survivor of human trafficking by the US Department of Health and Human Services.
I believe the first 6 items are the most important ones and are listed as follows:
1. Can you leave your job or situation if you want?
2. Can you come and go as you please?
3. Have you been threatened if you try to leave?
4. Have you been physically harmed in any way?
5. What are your working or living conditions like?
6. Where do you sleep and eat?
Chapter 5 presents the legislative efforts to combat sex trafficking as in the US Trafficking Victims Protection Act of 2000, the first legislation specifically designed to combat human trafficking and directly criminalize labor and sex trafficking.
Chapter 6 covers "Trials and Tribulations," which contains neither the trials and tribulations of survivors of trafficking nor the trials and tribulations of the health care providers in human trafficking but the importance of prosecutions of sex traffickers. It provides strategies for successful sex trafficking prosecutions and case examples.
Chapter 7 discusses sexual trafficking and designing experiential learning for students in the health care professions including educational approaches and design such as problem-solving learning and resiliency-based learning. Several educational designs are offered such as interdisciplinary education, faculty participation, preparation for learning, face-to-face encounter, and transformational learning.
Part I closes with chapter 8 on "Trafficking and Women of Color (WOC)." "Women of color" has its roots in the women's movement dating back in the late 1970s. The late 1970s was accentuated by the 1977 National Women's Conference when organizers of the conference developed the "Minority Women's Plank." Minority Women's Plank spurred the creation of "The Black Women's Agenda" and through negotiations became the "Women of Color." "Women of color" was intended to transcend and embrace shades of color, to unite women with shared cultural and global experiences: race, class, oppression, intersections, targets and prizes of wars, loss of autonomy, violence as a norm, stolen legacy, economic disenfranchisement, cultural and racial oppression, sterilization, mutilation, and genocide.
Part II has 12 chapters. Chapter 9 presents first-person accounts of illnesses and injuries sustained while being trafficked. As a research study, it starts with the purpose of the study followed by a research question: What types of injuries and illnesses are experienced by women and children enslaved in the sex trade? The significance of the problem was explained followed by a review of the literature. This qualitative research used content analysis technique as a method to collect data on the injuries and illnesses from study participants in order that clinicians learn to assess the health needs of survivors of trafficking patients when they visit emergency departments or clinics. Results were presented in great clarity and interesting detail of personal accounts and description of injuries and illnesses participants suffered.
Chapter 10 presents 2 categories of human trafficking as labor and sex trafficking and the health issues and consequences of human trafficking. Chapter 11 presents a human trafficking toolkit for nursing intervention based on Zimmerman's recommendation that, with human trafficking, health care interventions should be stage based wherein the intervention is based on the stage of trafficking the patient is in: predeparture stage, travel and transit stage, destination stage, detention, deportation, criminal evidence stage, and integration and reintegration stage. Furthermore, the principles of primary, secondary, and tertiary levels of prevention were explained as helpful in developing intervention strategies.
Chapters 12 to 17 cover pregnancy, malnutrition, drug use and abuse, sexually transmitted infections, physical trauma, and tuberculosis, pediculosis, and scabies as they relate to the clinical issues and perspectives in caring for survivors of trafficking. Chapter 18 covers a helpful and robust presentation of policy and procedures guide for emergency departments and community-based clinics focusing on providing for the safety of the patient and staff and building rapport with the patient. Chapter 19 presents mental health perspectives on the care of survivors of human trafficking within the US borders including strategies in identifying, interacting, and developing a mental health plan of action. The last chapter, chapter 20, is the mental health intervention as continuation of chapter 19's plan of care. It provides a review of therapeutic methods such as trauma-focused cognitive behavioral therapy, dialectic trauma-focused cognitive behavioral therapy, family therapy, peer support groups, eye movement desensitization and reprocessing, psychopharmacology, expressive therapies, art therapy, music therapy, poetry therapy, sand tray therapy, and animal-assisted therapy. These therapies are discussed in varying depth and breadth. It would have benefited the reader if under each therapy a case study was included or the included case studies are classified according to the type of therapy used. However, it is understandable that the author may not have used in practice all the therapeutic methods enumerated above.
An added feature of the book that is most useful in any practice is the 6 appendices: Policy and Procedures for the ED on Human Trafficking, Principles and Definitions, Patient Referrals, Tertiary Screening and Interviewing, Curriculum Plan for Staff Development on Human Trafficking, and a rarely seen Common Emergency Room Lab Values. Common Emergency Room Lab Values appendix in a book on "Human Trafficking: A Clinical Guide for Nurses" is uncommon but an important addition.
Finally, as an observation, "Human Trafficking: A Clinical Guide for Nurses" could have been the accurate title of this book instead of "Sex Trafficking: A Clinical Guide for Nurses" because most of the chapters and content address human trafficking. Furthermore, "human trafficking" is an umbrella term for all trafficking whether they be sex or labor trafficking. In closing, I believe that, for some readers of this book, a prophetic moment could hit them as an 18-wheeler[horizontal ellipsis] what on earth could be more important than helping just one child, just one helpless survivor of human trafficking.
Rose E. Constantino, PhD, JD, RN, FAAN, FACFE
Associate Professor at the Department
of Health and Community Systems
University of Pittsburgh School of Nursing
Pennsylvania