Human Trafficking: The Role of the Health Care Provider

Tiffany Dovydaitis, RN, WHCNP

Disclosures

J Midwifery Womens Health. 2010;55(5):462-467. 

In This Article

Clinical Implications: Caring for a Victim of Human Tracking

Identification

The Campaign to Rescue and Restore Victims of Human Trafficking provides a list of possible clues that someone may be a victim of trafficking: 1) evidence of being controlled; 2) evidence of an inability to move or leave a job; 3) bruises or other signs of battering; 4) fear of deportation; 5) non–English speaking; 6) recently brought to this country; and 7) lack of passport, immigration, or identification documents.[23] Health care provider tools, including screening tools and posters for the office, are available on the campaign's Web site.[24] Although this list of clues could be used for multiple other problems (e.g., domestic violence), they indicate the need for further investigation by the provider.

Victims will likely fear authority figures and be reluctant to give out personal information, so interviewing the client can be difficult. The first steps to a successful encounter are getting the client alone (victims are often accompanied by another person), finding an interpreter if necessary, and building a trusting rapport with the client. Because the client is unlikely to identify herself as a trafficking victim, the provider needs to pay attention to subtle and nonverbal cues.

Treatment

Responding to all of the victim's physical and emotional needs is outside of the scope of the individual provider's practice, because the client will need long-term treatment with an interdisciplinary team of health care professionals. The provider should care for any immediate needs, including treatment of physical trauma, sexually transmitted infections, diagnosis of pregnancy, and assessing for suicidal ideation.

Making a Plan

Once a victim of trafficking is identified, the clinician and client will need to put together a plan of care. The health care provider should be aware of the following: 1) the provider cannot force the victim to report the crime, and 2) the victim and/or victim's family may be at risk for immense harm if she reports the crime. If the victim is a minor, the provider is under legal obligation to phone child protective services.

The plan of care will be client-specific, but the provider should consider phoning the National Human Trafficking Resource Center (1-888-373-7888). This national referral line can assist in finding local resources for the victim and developing a safety plan that is acceptable to the client. Because victims of human trafficking have already experienced significant powerlessness, this is an opportunity for the provider to purposively give the client some decision-making ability. For example, the provider and client can anonymously call the referral line together and ask pertinent questions about the client's situation. Or the provider can give the client a phone, the phone number, and a safe space in which to make the call herself. The clinician is not mandated by law to call anyone (either the referral line or law enforcement) unless the client is under 18 years of age. While the clinician may call the referral line anonymously without the client's permission, it is not advisable to make an official report without the client's consent. Please note that this is a gray area and that each clinician will have to make his/her own moral decision regarding the reporting of suspected trafficking.

If the client does contact the National Human Trafficking Resource Center, the staff member on the line can help the victim get to a safe place. Once in a safe location, the victim can choose to pursue the certification process, which is part of the Victims of Trafficking and Violence Protection Act.[25] Certification provides the victim with the documentation required to remain in the United States legally and receive benefits and services under federal/state programs. If the victim is already a US citizen or a minor, she does not need to apply for certification, because she is already eligible. Examples of federally funded services and benefits are health care, translation, witness protection, legal representation, job training, transportation, and access to housing. In order to be certified, the victim must meet the following criteria: 1) be a victim of trafficking; 2) be willing to assist with the investigation and prosecution of trafficking cases (or be unable to cooperate because of physical or psychological trauma); and 3) have completed an application for a T visa.[26]

When a victim is undocumented, deportation will likely be of great concern and a possible barrier to reporting a crime. In response to this reality, the US Department of Justice created the trafficking visa (T visa), which allows the victim (and certain family members) to remain in the United States legally if the victim complies with "reasonable requests for assistance in the investigation or prosecution of acts of trafficking." Recipients of the T visa are eligible for legal employment and can become lawful permanent residents after 3 years.[27] Even with the availability of the T visa, the undocumented immigrant cannot be completely assured that she will not be deported if denied the visa, and it is important for the provider to not make any promises about immigration status.

As the omniscient reader of the case study presented in Box 3, how might you advise the clinician to proceed? There are multiple possible outcomes to this scenario. Two possible outcomes are:

  1. The clinician conducts a medical history and physical examination with the help of the unknown male as interpreter. After taking cervical cultures for gonorrhea and chlamydia, the clinician makes a presumptive diagnosis of pelvic inflammatory disease (PID) and gives S.M. a prescription for antibiotics. She explains the serious nature of PID to S.M. and the importance of having her sexual partner tested. She makes a follow-up appointment, the clinician thanks the male for interpreting, and S.M. leaves the clinic with him. S.M. does not return for her next appointment.

  2. The clinician begins obtaining S.M.'s history with the help of the unknown male as interpreter. She also asks the office secretary to try and find a language line interpreter who speaks Mixteco. She conducts her physical examination and collects cervical cultures for gonorrhea and chlamydia. She makes a presumptive diagnosis of PID and gives S.M. a prescription for antibiotics. The office secretary informs the clinician that she's found an interpreter on the language line, who speaks Mixteco. The clinician asks the male to leave the room, explaining that she would like to talk to S.M. alone about her medications. The male argues with the clinician, but leaves the room when she insists. Using the language line, the clinician is able to talk with S.M. freely. After some time has passed, S.M. begins to cry and tells her about the multiple sexual partners and the threats of the smuggler. The clinician talks with S.M. about trafficking and validates her fears. Together they make the decision to call the National Human Trafficking Resource Center and ask for advice on how to proceed. Through this phone call, the clinician and S.M. are connected with a local crisis center that assists S.M. with an escape from her smuggler and trafficker. S.M. and her child are safely sheltered and the process of applying for a T visa and certification begins. The clinician learns later that through the certification process, S.M. was able to stay in the US legally and bring her mother and other children over safely as well. A police investigation is ongoing.

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