Traffic Detail: Nurses at the Intersection

The United States is known as a destination country for human trafficking networks that bring people into the USA for purposes of both sexual and labor exploitation. This is true in Hawaii and every other state. Considered a modern form of slavery, trafficking victims in the United States are primarily from Asia, Latin America, Eastern Europe, and Africa. Cases involve both documented and undocumented workers, and they can occur in both legitimate and underground industries. Many human trafficking victims are vulnerable individuals who were born in the USA.

Case Study:  N

When she was fifteen, N’s family sent her to live with her uncle in the USA.  There was little money at home and her uncle promised she would go to school and she would work for him part-time in his corner store after school. But when she arrived she was put straight to work. N kept house in her uncle’s home all day, and he made her work as the cashier in his store until late every night. He did not pay her for her work and he said  that she was selfish to want to go to school.

N. lived like this for two years, working long hours and experiencing constant verbal abuse from her uncle. Whenever N. asked when she would be allowed to go to school, her uncle punished her by preventing her from speaking mother in her home country. One day, N. decided she could not take it anymore and ran away.

After meeting some other run-away teens, N. sought out services from a local homeless youth organization. She met with a case manager and stayed in the youth shelter for 30 days. During that time she also made connections within the community and a family decided to take her in. Her case manager continued to work with N. to help her adapt to the cultural, religious, and lifestyle changes of living in the USA. Her English improved significantly and she completed her high school education, winning awards along the way. N. has been able to re-connect with her family and hopes to visit them soon. In the meantime, she is attending college and wants to become a nurse.

What is Human Trafficking?

Human trafficking, a modern form of slavery, can involve sexual exploitation or  forced labor.   People may be forced to work as prostitutes, strippers,  pornographic models, or to be  mail-order brides (Richards, 2014). Forced laborers work for little or no money, often for long hours, and without appropriate safety measures or compensation. Female victims of forced labor are also often sexually exploited (U.S. Department of State, 2005).

Research shows that in the United States, sex trafficking of U. S. citizens is more common than labor trafficking; labor trafficking is more prevalent among foreign nationals (Sabella, 2011). Trafficking victims in the United States come from all over the world, but not all of these victims originate from other countries.  Runaways, homeless and orphaned teens, immigrants,  people with histories of trauma or violence, and women in general are vulnerable to trafficking (Greenbaum, 2014, Institute of Medicine, 2013, National Human Trafficking Resource Center (2012).

What Can We, as Nurses, Do?

Nurses are the most likely professionals to interact with with trafficked women and girls while they are still in captivity.  28% of trafficked individuals are seen by a nurse while they are enslaved (Dovydaitis, 2011). As members of the most trusted profession, we need to be aware of the warning signs associated with human trafficking. The National Human Trafficking Resources Center (2012)) identified these warning signs:

  • Presence of cotton or debris in vagina and/or rectum,
  • Problems with jaw or neck,
  • Inability to keep appointments,
  • No identification,
  • Tattoos or branding,
  • Accompanied by a person who does not allow her to speak or does not want to leave her alone during interview and/or care,
  • Inconsistent stories (conflicting stories or misinformation),
  • May not speak English, and
  • Lack of documentation of age appropriate immunizations and health care encounters.
  • Payment of services in cash.

According to the World Health Organization “Interviewing a woman who has been trafficked poses safety concerns for the woman, others close to her, and for the interviewer. For this reason, the interview technique must be specific to the situation in order to avoid the potential for causing harm” (World Health Organization, 2003). Nurses should be specifically trained about the safety needs of this vulnerable population, including how to phrase conversations, and be aware of  the availability of appropriate resources for immediate and follow-up care. We need to be familiar with our agency’s policies and the implications for anonymity, confidentiality, and informed consent.

Dr. Harise Stein, at Stanford University has suggested the following health history questions to screen for human trafficking:

  • What type of work do you do? What are your work hours?
  • How often do you get to visit/speak to your family or friends? Does anyone monitor of forbid your conversations?
  • Can you find another job if you want?
  • Can you come and go as you please?
  • Have you or your family been threatened if you try to leave?
  • Where do you eat and sleep? What are the conditions like?
  • Are you being paid? Do you owe money to your employer?
  • Do you have control of your money and ID/documents?
  • Do you ever feel pressured to do something you don’t want to do?
  • Have you been physically hurt?
  • Did someone tell you what to say today?

Before we can ask these questions, we need to have a plan, indeed a policy and procedure, for what to do if the answer to any of these questions leads us to suspect a problem. Poor planning or confusion will inevitably have a poor result: Human traffickers are criminals and capable of inflicting  serious harm on the patient and the nurse, as well as others in the environment. 

It would be important to learn about our facilities policies & available resources for helping survivors of human trafficking.  If there are none,  we need to bring it up to our managers.  Human Trafficking is a serious problem that causes a huge amount of human pain & suffering.  We, as nurses, can make a difference.

For more information, visit the following sites:

Office of Justice Programs

NWH Journal Human Trafficking

NYC “Let’s Stop Human Trafficking”

Another excellent set of resources can be found at the US Office for victims of crime, a site we, as nurses are not generally familiar with.