Educating Healthcare Providers on Human Trafficking

There are approximately 40.3 million victims of human trafficking around the world, according to the International Labour Organization. That includes people trapped in forced labor and sexual exploitation. “It’s often referred to as modern day slavery,” says Michele Reali-Sorrell, MSN, SANE-A, SANE-P, Cleveland Clinic’s enterprise nurse manager for forensic nursing. “People think slavery is gone, but it’s not. It just looks different in 2019 than it did hundreds of years ago.”

Reali-Sorrell and her team of 60 forensic nurses work on call at three trauma centers – Fairview Hospital, Hillcrest Hospital and Akron General – to combat human trafficking, as well as child abuse, elder abuse, domestic violence, intimate partner violence and sexual assault. “We are seeing human trafficking. It’s hidden in plain sight,” she says. “Patients are coming to us for medical problems that may or may not be related to trafficking. They may come for an STD check or an asthma exacerbation.”

Identifying the vulnerable

Cleveland Clinic’s forensic nurses have begun providing in-service education to healthcare providers at every emergency department in the Cleveland Clinic healthcare system, as well as family health centers. They explain what human trafficking entails, how to recognize victims and what treatment and follow-up options to offer victims.

Offering education to healthcare providers is critically important to combat the problem of human trafficking, says Reali-Sorrell. “Data has shown that almost 88 percent of survivors interviewed disclosed that they had been in a healthcare facility while actively being trafficked, and 63 percent of those had been in an emergency department,” she says.

In addition, the long-term effects of human trafficking place a heavy burden on the healthcare system. “When victims are rescued or leave the situation, they often have issues with alcohol and drugs, depression, anxiety, post-traumatic stress disorder or suicidal thoughts,” says Reali-Sorrell. It can also lead to exacerbation of chronic conditions, such as asthma or diabetes.

During in-service education, Cleveland Clinic’s forensic nurses explain that while anyone can become wrapped up in human trafficking, there are several factors that increase vulnerability:

• Homelessness.
• Poverty.
• Lack of access to education.
• Lack of access to job opportunities.
• A dysfunctional home environment.
• Conflict/violence.
• Disabilities
• Encounters with child welfare or juvenile courts.
• Being LGBTQ.

Watching out for signs

Victims may seek medical services for a variety of situations, ranging from emergencies and assault to workplace injuries and gynecological concerns. Whenever someone comes into the medical system, Reali-Sorrell encourages healthcare providers to look for the following signs of possible human trafficking:

• Multiple or recurrent STDs.
• Signs of physical trauma.
• Somatization symptoms, such as recurring headaches or abdominal pain.
• Suspicious tattoos or branding, often the name or nickname of the trafficker.
• Trauma to the rectum or vagina.
• Depressed mood or a flat affect.
• Anxiety or panic attacks.
• Frequent ED visits.
• Signs of drug or alcohol abuse.
• Lack of eye contact.
• Lack of identification.
• Lets other people speak for them.
• Unexplained or conflicting stories.

“Nurses [and other healthcare providers] need to use trauma-informed, patient-centered care to ask questions and maybe look a little deeper at patients when things just don’t feel right,” says Reali-Sorrell.

She recalls a recent case of a young girl who had gotten into a physical altercation and was brought into the emergency department by the EMS. The girl had a laceration above her lip and a black eye. “We could’ve stitched up her lip, done a CT of her eye to make sure there was no orbital fracture and sent her home,” says Reali-Sorrell. But the forensic nurse gently asked the patient more questions about the fight and learned that the argument was over a cell phone and debt with another girl. “Before you know it, the girl disclosed that she’s being trafficked,” she says.

Partnering with other organizations

While the education provided by forensic nurses won’t solve the problem of human trafficking, it’s an important start. “You won’t learn everything you need to know about human trafficking in short in-services,” acknowledges Reali-Sorrell. “What you will learn is to change the lens on how you see things. If you think something doesn’t look right, then consult social services or forensic nurses.”

Cleveland Clinic is part of Northeast Ohio’s Collaborative to End Human Trafficking, a group of dozens of organizations dedicated to addressing the complexities of this human rights issue. Reali-Sorrell and her peers work hand in hand with other groups in the collaborative to help their patients. “We’re not equipped to fix it all in the ED. Patients often need education, housing, detox services, clothing and more,” she says. “We work hard to see what other resources in our community we can connect them with.”

The effort to combat human trafficking can seem daunting. It is a $150 billion industry worldwide, according to the International Labour Organization. But Reali-Sorrell believes that nurses can make a difference.

“As our patients’ advocates, we need to blend together the science of nursing and the art of nursing. We are really good at identifying the medical part of the equation. We also need to be able to ask more questions of patients who we think are at risk,” she says. “If we pull together on this issue, we can identify, help and change the problem.”