Healthcare: Are your staff educated to recognize human trafficking?

Healthcare: Are your staff educated to recognize human trafficking?
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When I was 14 years old, I was lured away from home by a man I met at a New Jersey shopping mall. This man told me that I was pretty enough to be a model and that I was too mature for high school. It was the summer after my eighth grade middle school graduation, and I feared high school. I was afraid of getting beat up in the hallways, and I was afraid of losing my friends. This man pretended to be my friend, a romantic interest even. He said he could help me find a glamorous job in Los Angeles, California. Within hours of running away, however, this man forced and coerced me into prostitution in Atlantic City, NJ.

It didn't take long for law enforcement to spot me - I was a young girl on Pacific Avenue wearing a red dress and oversized high heel shoes. Unfortunately, I wasn't immediately seen as a victim of a crime. I was seen as a criminal, a juvenile delinquent, and I was arrested for prostitution. The most painful part of this experience wasn't what happened to me in Atlantic City, it was the way I was treated after Atlantic City - by law enforcement and even hospital staff. Today, I'm passionate about sharing my story and working with front-line professionals. By understanding my mindset and needs as a young victim of sex trafficking, professionals will be better equipped to recognize and respond to this victim population.

Recently, I joined Dignity Health as Patient Care Services Program Director, overseeing a program to identify and effectively respond to victims of human trafficking in the healthcare setting. As one of the largest healthcare systems in the nation, and the largest hospital provider in California, Dignity Health is positioned to affect the lives of many, including patients who are vulnerable to human trafficking. A 2014 study found that nearly 88% of sex trafficking survivors reported having contact with the healthcare system while being exploited. The study reveals how medical providers are "woefully unprepared" to identify and respond to victims. At Dignity Health, we aim to change that, and we started with education, implementation of internal protocols, and identification of community resources that can assist trafficked persons.

In order to be successful, any program of this design must ensure staff are educated on what human trafficking is and isn't. There are many myths and misconceptions associated with this crime. Unless all staff are well informed, victims can and will be missed in the healthcare setting. At Dignity Health, with support from the Dignity Health Foundation, we created a series of educational modules, the first of which dispels 10 myths often associated with human trafficking. Following are a few summarized examples:

Myth: Human trafficking only happens overseas.
Truth: Every country is affected by human trafficking, including the United States. The United States passed federal legislation to outlaw two common forms of human trafficking: sex trafficking and labor trafficking. Human trafficking is defined as forcing or coercing a person to perform commercial sex or labor/services. Labor trafficking includes situations of debt bondage, forced labor, and involuntary child labor. A commercial sex act is defined as any sex act on account of which anything of value is given to or received by any person (e.g. money, drugs, survival needs). Under federal law, anyone under age 18 who is induced to perform commercial sex is a victim of human trafficking - no force or coercion is required.

Myth: Only foreign nationals are trafficked in the United States.
Truth: U.S. citizens are also at risk of human trafficking victimization within the United States. In 2015, there were over 5,500 cases reported, and least 1,660 of these cases involved victims who were U.S. citizens or lawful permanent residents.

Myth: Human trafficking and human smuggling are the same crime.
Truth: Human trafficking is NOT the same crime as human smuggling. Human trafficking is a violation of someone's human rights. Human smuggling is a violation of a country's immigration laws. A person can consent to being smuggled into the country; however, if that person is forced or coerced into commercial sex or labor, then he/she may be a victim of human trafficking.

Myth: Everyone involved in prostitution is doing so by choice.
Truth: Oftentimes adults are choosing to perform commercial sex work (e.g. prostitution, stripping, pornography) due to a lack of options as opposed to an actual choice. We must refrain from passing judgement onto commercial sex workers and we must offer compassion and resources to any patient in need of help. Many survivors of sex trafficking reported feeling so isolated and stigmatized by society that they felt unable to reach out for help.

Myth: Victims of human trafficking will reach out for help.
Truth: Oftentimes victims of sex trafficking, especially youth, do not self-identify as victims. Due to prior abuse, victims may not realize they are being manipulated or exploited. Sex traffickers often target abused/vulnerable youth. Victims of sex or labor trafficking may blame themselves, may fear authorities, or may fear retaliation by traffickers. Foreign national victims may not speak English and may not know their rights in America.

Myth: All traffickers are stereotypical "pimps".
Truth: When we hear the term pimp, we often think of the stereotypical pimp with the flashy hat and clothes. Although these pimps exist, they are no longer the norm. Anyone can be a trafficker, including family members, friends, and neighbors. One mother sold her 7- and 14-year-old daughters for sex at truck stops in Nebraska. "Pimping" has become so normalized and even glamorized in the media that many young men and boys, especially gang members, want to become pimps. Gangs consider it easier to sell a person for sex than to sell drugs or guns. Drugs and guns can be sold only once. A person, however, can be sold for sex over and over again.

Myth: Human trafficking refers only to sex trafficking.
Truth: Labor trafficking often does not get as much attention in the media as sex trafficking; however, labor trafficking in the United States is real. Labor trafficking has been identified in industries like agriculture, hospitality, domestic work (e.g. live-in maid), and traveling sales crews. Victims may be charged a fee that's impossible to pay off (i.e. debt bondage). Victims may be forced to work 12+ hours per day, 7 days per week. Victims may not be allowed to leave the work premises and may be forced to sleep on the floor or in a makeshift bed in the back of the business. Victims of domestic servitude may be forced to sleep in the home. Victims working in traveling sales crews may be forced to sleep in a van.

At Dignity Health, our core mission is to deliver compassionate, high quality, and affordable health services, to serve and advocate for those who are poor and disenfranchised, and to partner with others in the community to improve the quality of life. In order to bolster this mission and generate compassion for victims, we include survivor stories in our education whenever possible. A survivor can help professionals see the humanity in those who are too often stigmatized by society (e.g. commercial sex workers, undocumented immigrants, homeless and runaway youth).

Basic education for healthcare staff should include red flags in the healthcare setting and the role(s) of front-line staff in established protocols. The National Human Trafficking Resource Center (NHTRC) hotline should also be included as a 24-hour resource to report suspicious activity, inquire about local resources, and seek support for a victim. The hotline number is 1-888-373-7888. If your healthcare facility implements a similar program, please continue to engage staff with ongoing education, survivor speakers, and awareness efforts in the facility.

As a former victim and Dignity Health ambassador, I thank you for your human kindness and for your mission to protect and advocate on behalf of victims of human trafficking. For more information and to support Dignity Health, please visit the Dignity Health Foundation website.

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