WASHINGTON, February 15, 2014 – Last month, the White House administration announced a five-year “Federal Strategic Action Plan on Services for Victims of Human Trafficking in the Unites States…, a collaborative effort involving more than 15 agencies across the Federal Government.”
As stated in last week’s article, the Plan outlines intentions for each agency to integrate the experiences and voices of survivors into their initiatives. One anonymous survivor responded to this ambition as follows: “For a successful collaboration there must be an intentional disbursement of power between the government agencies that have traditionally held all the power of decision-making and the survivor groups that have held none.”
In response to the Plan, the Department of Health and Human Services’ Administration for Children and Families created a technical working group with the goal to enhance the health care system’s response to human trafficking. Among those invited to attend the first session were medical and health professionals, service providers, advocates, researchers, and survivors of human trafficking.
In this article, I’d like to include some perspectives from survivors who were unable to attend the meeting. Following are the questions I posed to survivors along with their answers:
What are the needs of human trafficking victims (both short and long-term) as it relates to healthcare providers?
One very important need for both short and long-term care is quality trauma-informed psychotherapy. Victims deserve to have a legal right to these services. Receiving such services from a counselor who has the training and understanding of trauma and its complexities can make all the difference in the world to a survivor’s process of healing. – Margeaux Gray
Do you have any advice for health professionals regarding the signs of human trafficking and/or how to identify potential cases of human trafficking? How do victims of human trafficking present in healthcare settings?
They can present with repeated STDs; repeated genital and oral infections; repeated, persistent bruising; signs of major depression. Also, it’s normal for victims to not answer or be honest in response to questions from healthcare professionals. Many victims are coached by their trafficker on what to say if asked any questions regarding their illnesses and injuries. They are also threatened on what would happen if they answer in any way other than what they are coached to say. – Margeaux Gray
Many survivors require medical care during their exploitation. Some reasons for first engagement may include: broken or fractured bones, physical signs of abuse, dehydration and exhaustion, pregnancy resulting sometimes in abortion or miscarriage, signs of forced miscarriage (e.g. beating, “falling,” “car accident,” etc.), STDs and routine STD checks, and feminine hygiene products (e.g. a tampon) being forced in a position where the woman is unable to retrieve. The last sign is due to the fact that most [victims of sex trafficking] are forced to work during menstruation. – Rebecca Bender
Oftentimes, when a medical professional is with a patient, they may not even know it. Even if the professional is suspicious of the patient’s behavior, the last thing many American medical professionals ever consider is human trafficking. This is the reason I provide trainings that provide tools on what exactly sex trafficking looks like and how to talk with victims; this assists both patients and medical staff in ensuring a positive outcome for all parties involved. For example, in my training I include red flags and indicators of sex trafficking in a medical setting, including the following: no insurance/cash pay; tattoos of traffickers name or initials and/or any tattoo referring to money or “daddy” especially in a provocative location that would only be visible during an exam; patient is not alone, often with a controlling male or another female claiming to be a friend or relative. – Rebecca Bender
Do you have advice on how health professionals should respond in the case of seeing these signs or potential cases?
Be compassionate and develop their patient’s trust. Spend extra time with them. Explain why answering your questions are important. Trust your intuition. Do not be afraid to report suspected abuse and trafficking. – Margeaux Gray
Knowing what questions to ask or not ask (which requires proper training). Don’t judge. if [adult victims] build a rapport with one particular doctor or nurse, but they’re not ready or able to disclose everything or speak to law enforcement, [then] just [continue to] build a connection, give them a number, let them know they can come back or call and speak to that same person. It is all about trust. – Anonymous
Did you encounter a health professional before, during, and/or after being trafficked? If yes, what did the health professional do right or wrong? What signs did they catch/miss?
I am a survivor of…child sex trafficking. I had many, very grown up medical issues while I was being trafficked. I feared going to the doctor. I was coached by my trafficker on what to say if I was asked about my issues. I was also threatened on what he would do if I said anything other than what he coached me to say. I was questioned only once by a healthcare professional. I was in grade school and had a serious medical problem as a result from trafficking, I was asked if I was sexually active. I responded no. I was never questioned again. During the eighteen years I was trafficked, no doctor or healthcare professional ever reported suspected abuse or trafficking. Not once. – Margeaux Gray
I was able to visit the doctor two times while in my situation, first visit my employer escorted me and was there with me [through] the whole process [so] no privacy, then the second [time] I was able to go by myself and I thought [it might be] my breakthrough. The doctor told me that he noticed something was [wr]ong but didn’t act right away because I was with my employer, so this time he asked me couple questions. After [my] response[s], he told [me] that he [was] going to help get [me] out from the situation. [But] when [I] went home, [he] call[ed] my employer [and told] what I [had] shared with him. [After that] my situation [went] from bad [to worse]…[In the end, it turned out] this doctor and my employer [knew] each other. – Anonymous
[In my experience there were always too many] doctors in the room, ask[ing] me the same questions over and over…I [got tired]…instead of them helping [me, they] just asked the same question over and over. I [was] never checked [for or questioned about] rape…I never [told] anybody because I was little and didn’t know. – Anonymous
What advice would you give health professionals regarding short-term and/or long-term health options for victims?
Be compassionate, understanding, and get trained on human trafficking and the complexities of trauma. Trauma can manifest itself in a physical as well as in psychological form. – Margeaux Gray
The first thing I can think of is trauma-informed care and I personally wanted to know exactly what was going on if I was being examined, when they were going to touch me, where and why, etc. – Anonymous
When you were in an aftercare shelter/program, did you encounter any issues?
When I was in the shelter, [there were too many] people in [the] room, no privacy…[When I stayed] at the crisis center, it was better because [there] were two people in [each] room. – Anonymous
One place [for adult victims] had 4 people in one tiny room but I got out of their quick and they had zero resources/case plan to help me rebuild so I ended up back on the streets and in the strip clubs, living out of motels and with customers, and getting caught up with another pimp. – Anonymous
[I was in a domestic violence] safehouse it was pretty nice, they were not equipped for [human trafficking] victims but they had a couple programs or attempts at programs/counseling [but it was] not enough…they were going to relocate me but a trafficker found out and was my only outside contact so when I had a meeting with a social worker he did all the talking and took over. – Anonymous
Margeaux Gray is an independent anti-trafficking activist, policy advocate, public speaker, and artist. “I have transcended my horror,” Margeaux stated, “and today [I] use my voice and art to educate, inspire, and empower others, as well as to inform educators and students.” Margeaux says her main focus as a survivor leader is to address the healthcare and aftercare needs of victims. For more information about Margeaux, please visit her website at geauxfreedom.wordpress.com, or follow her on Twitter @geauxfreedom.
Through her ministry, Rebecca Bender offers a variety of secular trainings for medical professionals, law enforcement, child welfare providers, attorneys, and criminal justice officials. Rebecca says all trainings are specific to her professional audience and cover a variety of topics, including: human trafficking in the United States, inside the minds of victims, how to talk to victims, misidentification, challenges that victims face, poly-victimization, how to represent and defend victims, and what to do after identification. For more information, visit www.rebeccabender.org.
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