Human Trafficking:

Clinical Presentation
&
Treatment
How to Care for
Trafficked Persons in the
E.D.
Makini Chisolm-Straker, MSII
Brown Medical School, Mt. Sinai School of Medicine
2007
 Instructional Goals:

• You will be familiar with the clinical presentation of

human trafficking victims in the E.D. in the U.S.

• You will be familiar with the appropriate treatment of

human trafficking victims.

• You will appreciate the role of emergency healthcare

practitioners in facilitating the escape of trafficked
persons.
 Instructional Learning Objective
(what you will do by the end of this session):

You will know the hotline to call when

a suspected trafficking victim
presents to the emergency
department.
Case
• obtunded teenage ♀, GCS 5
• extensive bleeding from vaginal canal
• visible burns, cuts, scars on wrists,
ankles, neck
• hx of schizophrenia?
• bro. concerned about a dangerous
abortion attempt
Human Trafficking is:

• the recruitment, transportation, transfer, harboring

or receipt of persons:

– by the threat or use of kidnapping, force, fraud,

deception or coercion, or by the giving or receiving
of unlawful payments or benefits

– to achieve the consent of a person having control

over another person, and

– for the purpose of sexual exploitation or forced

labor.
Human Trafficking is:
• the illegal use of a variety of means
• to force an individual (the trafficked)
• to relinquish his/her personal freedom
• for the profit of another person (the
trafficker).
• often, simply considered “involuntary
servitude” or “modern-day slavery.”
 Types of Trafficking
Sexual Exploitation
• prostitution
• pornography
• bride trafficking
• commercial abuse of children
• massage parlors, hostess clubs, brothels,
escort services, commercial phone sex &
internet dating
• exotic dancing/stripping
 Types of Trafficking
Forced Labor
• domestic servitude (domestic work & child
care)
• manual labor
-small-scale factory work
-construction work
-sweatshops & farms of multinational corps
-agricultural & landscape work
• restaurants
• nail salons
• hotel housekeeping
• false adoption
• drug trade
• street begging
• camel jockeys
• child soldiers
• organ harvesting
 Trafficking Affects
(Populations at Risk):
•15,000 – 60,000 people are trafficked into the
U.S. annually
•80% of trafficked persons are ♀ & children
•U.S. citizens
•U.S. residents
•documented immigrants
•undocumented immigrants
•youth (esp. runaways)
•urban pop.
•suburban pop.
 Role of Healthcare Practitioners
in the E.D.

• Identify human trafficking victims

• Treat the chief complaint/illness and/or the

emergent issue

• Offer (& provide, if patient-desired) appropriate

treatment for the unsafe environment
 Difficulty Identifying Trafficking Victims

• distrust of service providers

• lies & false stories

• untrustworthy interpreters

• “one shot”

• difference between intimate partner violence &

human trafficking
 Signs & Sx

• lack of knowledge of a given community/whereabouts

• not in control of personal ID
• few ➔ no personal possessions
• does not speak
• 3rd party insists on being present or interpreting
• injuries (multiple, old & new)
• signs of malnourishment
• branding
 Signs & Sx

• no healthcare
• under 18 & in sex industry – DE FACTO
• claim of “just visiting”
• inconsistent story
• behavior change when “law enforcement” is mentioned
• STIs
• bacterial &/or yeast infxns
• demeanor (e.g.: fearful, anxious, submissive, flat
affect)
 What to do
What to do

• building trust is the number one priority

• reassure the potential victim
• one-on-one interactions are ideal
• specifically ask about the patient’s safety
• offer reworded stories
• stay calm & even-keel
• ALWAYS document your suspicion in your
notes, at the very least
 8. Call a Help Hotline:

English: 1-866-US-TIPLINE

Korean: 1-888-976-5274

Spanish: 1-888-80-AYUDA
The folks working at the hotlines are trained to know
how to help you, but you are their eyes & ears.

Trust their knowledge, your experience & your gut.

If the patient is an adult, they have the last say, but

give them every opportunity to receive help.

Even if a potential victim doesn’t want help,

call:
1 - 8 6 6 - U S - T I P L I N E,
to report suspected trafficking;
the tip can save lives.
 Clinical Recommendations*
Presumptive Treatment for:
• gonorrhea
• chlamydia
• trichomoniasis
• syphilis
• UTI

*for sexually exploited victims

 Special thanks to Polaris Project
for the images & information.
Clinical Recommendations courtesy of
Doctors of the World.
 For more information on
trafficking in the U.S.
you can:

email: m.chisolmstraker@gmail.com

visit: www.polarisproject.org
or
www.humantraffickingED.com