The Massachusetts Medical Society has published a guidebook for healthcare providers on how to identify, assess and respond to victims of human trafficking.
The 44-page guidebook is the result of a three-year research collaboration between Massachusetts General Hospital and the state’s medical society. The senior author is Dr. Wendy Macias-Konstantopoulos, medical director of Mass General’s Human Trafficking Initiative and chair of the medical society’s Committee on Violence Intervention and Prevention. She says healthcare providers are some of the only people who come in contact with and are able to provide help for victims.
“Studies that we have, albeit limited, do show that they’re accessing healthcare through emergency departments, community clinics and other venues,” Macias-Konstantopoulos said. “We believe that they’re accessing care when they sustain an injury that is severe enough that they can no longer work.”
Dr. Elaine Alpert is the founding chair of the violence intervention committee and the guidebook’s first author, which focuses on labor, sex and organ trafficking.
“These young victims of sex trafficking not only suffer from terrible physical injuries, sometimes they have unintended pregnancies and forced abortions,” Alpert said. “They can have sexually transmitted diseases. Because they are so young some of them may have physical injuries from repeated sex acts. They often bear tremendous emotional scars from the victimization that they’ve undergone. Particularly because the people who got them into the trafficking situation started out as people who they thought loved them. People who they trusted, looked up to, gave them gifts, took care of them and promised to be kind and protective of them. This breach of trust can have tremendous emotional implications that are very, very hard to see and may be lifelong.”
Aside from physical indicators, the guidebook provides what’s called a human rights focused and trauma informed approach for identifying trafficking victims. Alpert says it puts patients in the driver’s seat, allowing them to answer the questions they want to without fear.
“Specifically for sex trafficking we ask, ‘Has anyone persuaded or forced you to have sex when you didn’t want to?’” Alpert explained. We ask, ‘Have you ever exchanged sex for food, shelter, drugs or money?’ We ask if they’re a runaway or if they are safe of if they feel they’re afraid of anybody? So these are general questions. We don’t say, ‘Are you a victim of human trafficking?’ because most people will never identify themselves as victims even when they know in their hearts that they are.”
The guidebook also offers legal and treatment resources healthcare providers can pursue for suspected victims. According to the U.S. State Department’s Trafficking in Persons Report there were nearly 45,000 trafficking victims identified globally in 2013. Meanwhile, the International Labor Organization estimates there are nearly 21 million forced labor victims worldwide. Noting it’s difficult to get hard numbers because of the very nature of the crime, Alpert expects trafficking reports to increase as healthcare providers become more informed and comfortable asking patients about the sensitive topic.
“So it may look like the problem is getting worse, when in fact it’s something we are hoping to see is that reports are increasing and therefore our ability to get help to those people in need is increasing,” said Alpert.