Readers of Home Healthcare Now know I like to give a shout-out to healthcare providers who go above and beyond. As a faculty member in the school of nursing at the University of Detroit Mercy, I recently received a forwarded e-mail congratulating one of our graduates, Megan Frost and her coworker Mary Barrett on a job well done. Megan and Mary are both registered nurses in the obstetrics department of a local hospital. A patient arrived, 23 weeks pregnant, with a history of having "fallen in the bathtub." The patient revealed to them that she was from Arizona and was being held against her will by the woman who had previously accompanied her to the hospital (who had self-identified as the patient's mother). She related an alarming story of meeting a "friend" online who sent her a bus ticket to go to Michigan. Once she arrived in Michigan, the "friend" disappeared and the patient was held captive, treated as a slave, and abused. This resilient woman managed to escape to a neighboring home and begged the residents at the house to call 9-1-1.
The patient had told other healthcare providers the same story, but due to her psychiatric history and intellectual disability, no one believed her. Research suggests that a high percentage of people who are victims of trafficking come in contact with healthcare providers while in captivity. Fortunately, Megan and Mary were familiar with human trafficking, and knowing this patient fit the profile, acted on the information she provided. They searched for her name on social media and the Internet and discovered she was indeed, listed as a missing person in Arizona. A call was made to the local police department, and a sexual assault nurse examiner (SANE) arrived at the hospital, interviewed the patient, and performed an exam. The patient received prophylaxis for sexually transmitted diseases and was moved to a safe environment, away from her captors.
There are two types of human trafficking: labor trafficking and sex trafficking. Labor trafficking involves forced work for example as a domestic servant, or in agriculture (Green, 2016). The patient Megan and Mary assisted was forced into the sex trafficking, the more common form of human trafficking, which claims an estimated 14,500 to 17,500 victims each year in the United States (Green). In this case, the victim was able to relate her story to her caregivers, and ask for help. Other victims may not be so forthcoming due to abuse by multiple captors that leaves them fearful of all people.
Some clues that may suggest a patient is a possible victim of human trafficking are fearful behavior and few or no family members. The story given might not match the injury or physical assessment findings. Another common clue is when those who accompany the victim to health-related visits refuse to leave the patient's bedside (out of fear they will divulge their true circumstances). When in doubt, separate the patient from those who accompany them so you can question the patient privately. Green (2016) suggests asking nonthreatening questions that require only short answers. Examples include "Where do you sleep?" and "Do you keep all the money you earn"? and "Can you come and go as you please"? Avoid using the word "trafficked" when questioning a patient, as this term may not be familiar.
Home care clinicians are in an ideal position to detect human trafficking. Are there household residents who appear fearful or on-guard? Do the interactions between people in the home reflect a power imbalance? Is there someone in the home that appears to be kept in another room when you are there? Does the person silently try to get your attention?
Do as Megan and Mary did-be open to their story, listen, and act. You may save a life.
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