Nurses Breaking the Cycle of Human Trafficking

The Eyes and Ears of Noble Compassion

Nurses have many technical skills and their role in health care has a wide range. The history of nursing is based on innovation, always striving to improve the delivery and access of health care.

Forensic nursing is a nursing specialty that involves caring for victims of crime, which includes sexual assault. Their job description also encompasses observation, collection of evidence and documentation of abuse of victims. It is the meeting of the health care and justice/legal systems. ER and public health nurses will see the most cases.

These positions were created by nursing innovation with the Sexual Assault Nurse Examiner (SANE) position in the 1970s. The first conference of the International Association of Forensic Nurses was in 1992. One of the stated goals of the IAFN is to “develop preventive strategies at every level of nursing work in an effort to bring about a world without violence.” Every nurse would be in agreement with that.

One of nursing’s core values is to relieve suffering. The SANE and FNE roles were created in response to the mainstream medical establishment’s view on treating sexual assault victims. The female FNE or SANE created a space for victims to feel safe, believed, and understood. These nurses were partners to bring about healing for these women and offered choice in treatment. The FNE or SANE looked beyond the physical trauma with a goal of psychological healing as well. This may have been missing in medical care for sexual assault victims before this nursing position was created.

One form of violence that nurses may unknowingly encounter is human trafficking victims. Nurses’ role in ER and public health means they are most likely the first health care professional to meet the trafficking victim or possibly be the only person to have any contact with him or her. Human trafficking can be defined as the recruitment, transport, concealment, and control of a person with the goal of exploitation and profit. The key word is control; the victim has little or no freedom to escape their circumstances.

Nurses are in a crucial position to break the cycle of cruelty and anonymity, through identification of potential victims. The US government agency has outlined procedures for health care professionals to assist them in identification, because the human cost in not detecting is immeasurable. For example in 2007 a young teen from Guatemala was sold by her parents to a trafficker who smuggled her to Florida. She was forced into the sex trade and became pregnant. She went into premature labor after being beaten by the trafficker, and was brought in to ER by a neighbor. Unfortunately the doctor did not recognize her as a trafficking victim at that time and it was only months later that her circumstances were discovered.

There are 4 steps that health care professionals can use to bring this crime to light. The first is noting the health problems the victim might present. They include: chronic diseases such as TB or STD, chronic pelvic, or excretory problems, or pregnancy especially in younger patients. The victim might be malnourished, or children could have stunted growth or dental problems. They could have infections or show signs of abuse or mutilation, such as cuts, bruises, or broken bones. The psychological symptoms of abuse could also be evident such as post traumatic stress syndrome, depression, phobias, and panic attacks or drug abuse. Sometimes the trafficker has tried to administer medical treatment before the victim is taken to a medical center.

Nurses also need to understand the perspective of the trafficking victim. They are fearful of authority, possibly because they come from a country where there is corruption. They are often kept in isolation and denied contact with their families and members of their community. Many times the victim’s first language is not English. They feel shame for having being duped with promises of a better life or escape from poverty.

Nurse’s communication skills and compassion coupled with careful observation will enable him or her to communicate effectively with the trafficking victim. They can arrive at the medical center without documentation or identification. If the nurse notes they are accompanied by a person that speaks for them and seems very controlling this may be a clue.

Screening questions will enable the nurse to gather more evidence to help identify a trafficking victim. These questions should be asked when the he or she is alone. The nurse can cite medical confidentiality to create this situation. Often patient doesn’t view him or herself as a victim in need of assistance, so indirect questions asked in an atmosphere of trust and safety are effective. Sometimes a translator is necessary. The nurse could ask them to describe their place of work or home. They could ask where they sleep or eat. They could ask about how easy or hard it would be to leave their job. They could ask of they are free to have food, water, medical care or if they can decide when to sleep or eat, or if they have freedom of movement, or if they can see their family. The situation becomes more complicated when the victim is a child.

Nurses are skilled at building trust. This trust can help break the cycle of human trafficking by empowering the victim to change their circumstances. The nurse is the portal to contact with community agencies that can assist in building a new life. Also a FNE can gather enough credible and effective evidence to convict the perpetrator.

Sexual assault and domestic abuse training for FNE will include education on human trafficking. All nurses are on the forefront of health care’s increased participation in dealing with human trafficking and bringing this hidden crime into the open. They will also be crucial in preventing new cases, and reducing its dubious status as the second most profitable organized crime worldwide.

“Working with trafficking victims is not specific to forensic nursing. Other nurses and health care professionals should get on board to recognize the signs and be ready to intervene. We can’t just put the onus on the trafficked person to seek help, or people will continue to be exploited.” (1)

(1) On the Lookout for Human Trafficking Canadian Nurse February 2011 pp 24-25

http://www.acf.hhs.gov/trafficking/campaign_kits/index.html#health

http://www.iafn.org/associations/8556/files/OTESummer2007.pdf

http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=398

Additional Information:
• US State Department Trafficking in Persons Report and their interactive map.
• Human Smuggling and Trafficking Center
• Coerce.ca Human Trafficking in Canada

© Young Lion Inc. 2011 - Photo Courtesy of Amnesty International