I met this afternoon with U.S. Department of Homeland Security (DHS) Secretary Janet Napolitano and others to discuss strategies to address the scourge of human trafficking, or modern-day slavery. (Sec. Napolitano is pictured at the bottom left in the photo, next to Alejandro Mayorkas, Director, U.S. Citizenship and Immigration Services. Standing next to me in the upper right is Shamere McKenzie, a trafficking victim turned activist.)
I outlined the plan below to Sec. Napolitano, who had been summoned by President Obama to a cabinet meeting within the hour.
She responded positively to the plan and noted, "I'll be meeting with [U.S. Secretary of Health and Human Services, Kathleen] Sebilius in about 20 minutes and I'll ask her to be involved." Alice Hill, Senior Counselor to Sec. Napolitano, noted that DHS had been working on the idea of outreach to the medical community since I had suggested the plan a year ago at the launch of the DHS Blue Campaign. DHS staff have devoted significant time and resources to fighting human trafficking, and have reached out to nongovernmental organizations as partners in that effort.
Medical - Law Enforcement Partnerships to Enhance TIP Victim Rescues, Health and Cooperation
Problems and opportunities
1. Increasing victim recognition and reporting by educating medical professionals
Victims taken to medical professionals during their captivity often are not recognized and reported,[i] because most medical professionals do not know the signs of trafficking victims or how and where to report suspected cases.[ii]
Healthcare professionals--especially those who work in emergency rooms, clinics in low-income areas and Obstetrics and Gynecology--need training to learn how to help recognize, report, rescue and restore victims of trafficking in persons (TIP) brought to hospitals and clinics for health needs.[iii]
Knowing how to identify and work with law enforcement officials plays a key role in this effort to increase the number of victims reported, rescued and rehabilitated. To conform to the continuing medical education (CME) requirements and expectations of medical professionals, the training should be developed and overseen by medical professionals.
2. Gaining the trust and cooperation of victims by meeting their health needs
Because victims often evidence the Stockholm syndrome and have been conditioned to view law enforcement officials as enemies rather than allies, a lack of trust can impede initial interviews, cooperation in prosecutions and attempts to persuade victims not to return to traffickers.
Law enforcement officials need to be able to enlist the help of healthcare professionals to initially interface with and medically examine victims immediately following raids and rescues, and also to provide ongoing medical care for victims.
By assisting in initial interviews of rescued victims, medical professionals can provide a readily trusted contact for victims who have been conditioned to mistrust law enforcement officials and even men in general. If one of the first persons a victim encounters is a caring medical professional who helps meet her health needs--for example, a female health professional caring for a female victim--that victim will much more likely cooperate with questioning and prosecution efforts.
3. Diagnosing diseases to treat victims and protect agents and caregivers
Absent medical protocols for interfacing with trafficking victims during intake interviews, victims may not receive immediately needed medical help, and law enforcement officials and caregivers unknowingly risk exposure to infectious diseases such as tuberculosis and typhus.[iv]
Developing protocols to immediately identify and address health problems, including infectious diseases, will help victims receive potentially lifesaving help while also protecting law enforcement officials and caregivers from potentially life-threatening exposure.
SUMMIT: Medical and Law Enforcement Partnerships to Stop Human Trafficking
Engage medical specialty group leaders and other healthcare leaders to educate and motivate healthcare professionals to partner with law enforcement officials in recognizing, reporting, treating and earning the cooperation of victims of human trafficking.
1. Leaders of medical specialty organizations whose members are most likely to see victims of human trafficking (e.g., American College of Emergency Physicians, American Congress of Obstetricians and Gynecologists, American Association of Public Health Physicians, etc.). Medical specialty groups reach hundreds of thousands of professionals.
2. Leaders of community and faith-based organizations that work with victims and/or are likely to have contact with victims.
3. Leaders of influential medical educational institutions.
4. Top officials representing public health agencies.
5. Healthcare specialists serving in crisis relief agencies, community health and faith-based programs and others working with vulnerable populations.
· Secretary of the Department of Homeland Security
· U.S. Surgeon General
· Member of Congress who sponsored TVPRA
1. Medical-law enforcement partnering to identify, report, treat and engage victims
· Outline steps to recognizing victims in healthcare settings.
· Explain methods and considerations for reporting victims to law enforcement authorities.
· Discuss the process of rescuing, interviewing, treating and earning the cooperation of victims in prosecutions, and how medical professionals can participate.
2. Federal TIP resources and how to customize them for specific medical audiences
· Overview medically related TIP education materials developed by federal agencies.
· Encourage attendees to customize the agency materials and develop their own national awareness education resources, adapted for the various medical specialty groups (e.g., Ob-Gyn, emergency medicine, public health) and types of medical professionals (e.g., physicians, nurses, support staff).
3. TIP medical working groups: Needs and opportunities
Solicit volunteers for two TIP medical working groups to develop:
· a formal medical protocol for use nationwide with victims immediately following raids and rescues; and
· a plan for a registry of medical professionals who will interface with victims immediately following raids and rescues.
[i]One study noted, "In all, 28 percent of the trafﬁcking victims that we interviewed came into contact with the health care system during their time in captivity—each one of those visits represents a missed opportunity for potential intervention or education about trafﬁcking." Turning Pain into Power: Trafficking Survivors’ Perspectives on Early Intervention Strategies. San Francisco, CA, 2005. Available at http://www.childhood-usa.org/upl/files/4109.pdf Accessed 8/1/2011.
[ii] A recent study examining the experience of emergency room personnel regarding trafficking victims found that although 29% thought it was a problem in their emergency department population, only 13% felt confident or very confident that they could identify a TIP victim, and less than 3% had ever had any training on recognizing TIP victims. Chisolm-Strike M, Richardson L. Assessment of emergency department provider knowledge about human trafficking victims in the ED. Acad Emerg Med 2007;14(suppl1):134.
[iii] The United Nations Declaration of Basic Principles of Justice for Victims of Crime and Abuse of Power (1985) 62 states that persons who are likely to be in contact with victims (such as staff from health and social services, and other personnel) should receive training in order to enable them to identify victims and to be sensitive to their needs (United Nations Office on Drugs and Crime, Trafficking in Persons Global Patterns, April 2006, p. 75).
[iv] The Salvation Army Anti-trafficking training manual prepared for the Office for Victims of Crime,
U.S. Department of Justice notes, "Another safety consideration is whether the victim has been exposed to infectious diseases such as tuberculosis, HIV, and typhus (Salvation Army, 2006) and the risk of exposure to others. This should be determined as part of an initial assessment or screening of the victim."