Victims of human trafficking come through the doors of our Urgent Care centers every day, without us even knowing. Human trafficking is when someone exploits another person by compelling them to perform some type of labor. We often think of sex trafficking, but victims of human trafficking can be coerced into any form of labor, including hospitality, agriculture, construction, and domestic services. It is hard to quantify the extent of the human trafficking issue, but experts estimate that some 24.9 million people are victims of trafficking worldwide. 

Human trafficking is a public health issue and experts have been pushing to get human trafficking on the radar of clinicians for some time. Dr. Hanni Stoklosa is one of them. Dr. Stoklosa is a nationally recognized human trafficking expert and advocate, an EM physician at Brigham and Women’s Hospital, a faculty member at Harvard Medical School, and the Founding CEO of the organization HEAL Trafficking. 

Most of us carry some assumptions about what human trafficking is, often shaped by what we see in the media. Dr. Stoklosa shares things clinicians can “unlearn” to take better care of people being trafficked. 

Unlearning #1: It’s Not About Rescue; It’s About Planting Seeds.

Our natural inclination is to rush in and help people out of trafficking situations. But this takes power and control away from the victim. Additionally, our good intentions can sometimes cause harm. An example of this is involving law enforcement. For many reasons, trafficking survivors may see law enforcement as foe and not friend.  Instead, clinicians should focus on planting seeds of resilience by acknowledging the victim’s strengths, providing resources, and assisting with safety planning. 

Unlearning #2: The Biases We Have About Who Experiences Human Trafficking.

All humans, including health care workers, have biases about who experiences trafficking and how trauma manifests. Victims of human trafficking can be of any age, gender, race, ethnicity, immigration status, and socioeconomic status. Know your biases and mitigate them. Dr. Stoklosa recommends using the Harvard Implicit Bias test as a tool to help identify your biases. 

Unlearning #3: Stop With the Screening Tool Frenzy!

Bulleted, screening checklists are not helpful when it comes to identifying trafficking survivors. Instead, we should focus on person-centered, trauma-informed approaches to assess victims of trafficking. Dr. Stoklosa recommends the PEARR Tool. This is an acronym that stands for Provide privacy, Educate, Ask, Respect, and Respond. Potential inquiry/screening questions include: 

• Have you ever worked, or done other things, in a place that made you feel scared or unsafe?
• Have you ever been tricked or forced into doing any kind of work that you did not want to do?
• Have you ever been afraid to leave or quit a work situation due to fears of violence or threats of harm to yourself or your family?
• Has someone you worked for ever controlled the money you earned, or kept money you earned in exchange for transportation, food or rent without your consent?
• Have you ever received anything in exchange for sex (e.g.: a place to stay, gifts, or food)?

What if a patient discloses that they are a victim of trafficking? First of all, be aware of your clinic or health care system’s protocols and the resources available to you (e.g., social work). The National Human Trafficking Hotline (1-888-373-7888) is a helpful resource for clinicians as well as patients. This hotline is available 24-7 and can provide information on support services in your community. Survivors can also text “Be Free” or 233733 to access this hotline and its resources.  

Do you want to hear more from Dr. Stoklosa? Check out Hippo Education’s Urgent Care Reviews and Perspectives (Urgent Care RAP) podcast for a conversation on this topic with Dr. Neda Frayha, internist and host of Hippo Education’s Primary Care RAP podcast. 

References: 

1. Chisolm-Straker, M. & Stoklosa, H. (Eds). (2017). Human trafficking is a public health issue: A paradigm expansion in the United States. Springer International Publishing.
2. Stoklosa H, Kunzler N, Ma ZB, Luna JCJ, de Vedia GM, Erickson TB. Pesticide Exposure and Heat Exhaustion in a Migrant Agricultural Worker: A Case of Labor Trafficking. Ann Emerg Med. 2020;76(2):215-218. PMID: 32362432.
3. Chisolm-Straker M, et al. Screening for human trafficking among homeless young adults. Children and Youth Services Review. 2019; 98:72-79.
4. Because human trafficking is a health issue. HEAL Trafficking: Health, Education, Advocacy, Linkage. https://healtrafficking.org/. Accessed December 6, 2022. 
5. About human trafficking – united states department of state. U.S. Department of State. https://www.state.gov/humantrafficking-about-human-trafficking/. Published August 18, 2022. Accessed December 6, 2022.