Medical Perspectives on Human Trafficking in Adolescents: A Case-Based Guide

360 Pages·2020·5.578 MB·English

by  Kanani E. Titchen, Elizabeth Miller

Medical Perspectives
on Human Trafficking
in Adolescents
A Case-Based Guide
Kanani E. Titchen
Elizabeth Miller
Editors
123
Medical Perspectives on Human Trafficking
in Adolescents
Kanani E. Titchen • Elizabeth Miller
Editors
Medical Perspectives
on Human Trafficking
in Adolescents
A Case-Based Guide
Editors
Kanani E. Titchen Elizabeth Miller
Division of Adolescent and Young Adult Children’s Hospital of Pittsburgh
Medicine, Department of Pediatrics Pittsburgh, PA
University of California San Diego and USA
Rady Children’s Hospital
San Diego, CA
USA
ISBN 978-3-030-43366-6 ISBN 978-3-030-43367-3 (eBook)
https://doi.org/10.1007/978-3-030-43367-3
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Kanani: For my patients, who teach me more
than any textbook or standardized test
ever could.
Liz: For the young people who have trusted
me with their stories over the years and
encouraged me to pursue this healing
profession.
Foreword
Though the United States Congress passed the Trafficking Victims Protection
Action of 2000 nearly 20 years ago, professionals in communities across the United
States often misinterpret or altogether fail to recognize the signs of human traffick-
ing and exploitation right here in our midst. Until recently, many professionals
engaged in anti-trafficking work viewed adolescent labor and sex trafficking strictly
as an international problem, unaware that precisely the same epidemic was rampant
in our own communities. Regrettably, the topic of human trafficking is largely
absent from the halls of academia, and students routinely graduate from their pro-
grams with little to no education in this area. In their regular course of practice,
physicians, like my own mother and her colleagues, provided compassionate care in
exam rooms and child advocacy centers to their patients experiencing extreme
forms of abuse and trauma but failed to understand the precise form of abuse that
was taking place: adolescent labor and sex trafficking. This is a far too common
problem. The indicators for human trafficking are routinely missed and classified as
domestic violence, familial child sexual abuse, intimate partner violence, or another
type of abuse or accidental injury. While those elements might be a part of a patient’s
experience, forced work or the exchanging of sexual acts for something of value is,
indeed, human trafficking. Early research tells us that patients experiencing exploi-
tation are likely to seek medical care while under the control of their traffickers,
making professional development for healthcare providers not only strategic but
critical.
I, too, became educated about human trafficking in the United States well after I
graduated from college. Once I understood the exploitation occurring in my own
community, providing trafficking-related professional development to community
stakeholders became my full-time passion, and, eventually, community mobiliza-
tion and capacity building became my full-time vocation. One night, I was called by
federal law enforcement to the emergency room at a local hospital to assist with a
young woman I had been working with who had been brutally beaten. Before the
SANE nurse entered the exam room, the federal agent and I gave the staff a quick
crash course on human trafficking. That overview for the staff was critical to ensur-
ing that their approach with the patient would be trauma-informed. Meanwhile, the
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viii Foreword
patient was waiting in the exam room wondering whether or not she should simply
leave. Though she had disclosed that she had been trafficked against her will, she
had experienced stigma in the past and was deeply fearful that she would be judged,
or worse, not believed.
How tragic is it that healthcare providers are mostly reactive in their approach to
trafficking survivors? And how many survivors arrive at emergency rooms without
the benefit of an advocate and law enforcement by their side? Patients experiencing
human trafficking routinely seek medical care, and not exclusively at emergency
rooms – they also frequent the offices of neurologists, obstetricians and gynecolo-
gists, child abuse pediatricians, and other specialists. All of these professionals pro-
vide care to patients experiencing exploitation and, therefore, must be equipped to
meet the unique needs of that population appropriately.
Community stakeholders, including healthcare providers, benefit from profes-
sional development on the topics of human trafficking and exploitation. Medical
professionals across the United States are now learning the signs of exploitation,
and what to do when they recognize the indicators. This resource is designed to go
beyond simply recognizing the signs of trafficking, to providing compassionate care
for patients experiencing trafficking.
The authors of this book are physicians who have consistently offered compas-
sionate care to patients experiencing trafficking, and because of their remarkable
care, their patients are returning to them. Providing appropriate, compassionate care
to survivors of human trafficking is not simply good bedside manner: it is the neces-
sary intervention. This is what it looks like to be truly victim centered.
Healthcare providers play a critical role in bringing about justice for survivors of
human trafficking. Other human service providers, prosecutors, law enforcement,
and community-based service providers cannot do this work alone. Human traffick-
ing is one of the most egregious human rights violations of our time, but we are not
helpless in the face of it. Knowledge is power, and together we can bring about real
hope and exact change. We invite you to learn with us and become an effective,
strategic ally in the effort to prevent and combat trafficking in persons.
Washington, DC, USA Heather Fischer
Preface
How do we reduce a person’s lived experience – a life lived in four dimensions – to
a story reported in two dimensions through ink on a page? When reading these lives
and while editing these life stories, these thoughts emerge. How would our own
lives be reflected in a case study? How much about us – the nuances of our vocal
tone, the subtleties of our gestures and expressions, the biting of our wit, the sur-
prise of our dark humor – would be lost?
How can a survivor crack jokes about her torture? Because she is more than a
survivor. She is a comedienne, a tree hugger, a fire spinner, a mother, an analyst, a
soul sister, a runner, a pianist, a legal advocate, a chocolate-lover.
How can a victim wax rhapsodic about the soap he used that time he was scrub-
bing blood out of his hair? Because he is more than a victim. He is a full flesh-and-
blood skateboarder, a brother, a disco dancer, a son, a writer, an athlete, an
intellectual, a baker.
Within these pages, we have reduced dozens of people full of character and joie
de vivre and desperation and angst and passion into the formulaic Case Study. As
healthcare workers and trainees, we learn from the Case Study. We take solace in the
predictability of the Case Study. The Case Study presents with this condition to that
medical setting. On history, they have X and Y and Z, and their vital signs are within
normal limits, and their physical exam reveals A and B and C, and follow-up labs
and imaging reveal… and our differential diagnosis includes…
But we recognize that behind this charade of medical detachedness and linear
thinking lives and breathes and sweats a human being engaged in life – sometimes
desperately surviving – and perhaps caught up in the web of human trafficking.
Human trafficking is a thing. It is a thing right here in our country, in our state, in
our town, and maybe even in our neighborhood.
In the case of this textbook, human trafficking is the thing. It is why we’ve
opened the pages of this book and scoured its stories for answers. What is human
trafficking? What is the difference between trafficking in humans and smuggling
humans? What is the difference between sex trafficking and “prostitution”? Between
labor trafficking and labor exploitation? How do we acknowledge the victimization
and the horrific wrongs done to the victim while we also honor the strength, the
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x Preface
resilience, and the phoenix rising in the survivor? Where is the line between being
trafficked and doing the trafficking? When is that line blurred? What are the signs of
human trafficking? What are the signs of human trafficking in the healthcare set-
ting? When should I report human trafficking? When should I refrain from reporting
human trafficking? Where is human trafficking occurring? Where – to which medi-
cal settings – are these trafficked persons presenting? Who is being trafficked? Who
is doing the trafficking? Who is seeing these patients and treating these patients?
Who is not seeing these patients but unwittingly treating these patients?
Why is human trafficking happening?
As to the why, we cannot adequately address human trafficking without also
addressing racism, misogyny, homophobia, transphobia, ableism, and poverty.
These are the drivers of enslavement, cruelty, and exploitation. They are concepts
and realities beyond the scope of this book… or any one book.
No one person can tackle these Goliaths. No one sector of society can defeat
them alone. As Ta-Nehisi Coates has said, enslavement is a system [1]. The reality
is that human trafficking is a system. It is a system from which many of us benefit:
within these chapter narratives, we may recognize in ourselves the moral failings of
those who we condemn or on whom we take pity. It will take all of us – survivors,
policy makers, healthcare professionals, legal advocates, law enforcement, social
workers, educators, artists, the tech community, business leaders, entrepreneurs,
and others – to address oppression and marginalization in our own communities. We
will need the community to show us the way.
Enter the Credible Messenger: “The idea that individuals with shared lived expe-
riences are uniquely suited to teach, support, and guide others through similar chal-
lenges can be found across ancient faith traditions and indigenous and tribal cultural
practices” [2]. Communities – and people – have within them the capacity for trans-
formation. Life experience can be a guiding force for youth on a path leading toward
self-destruction, victimization, and conflict with the justice system.
The Credible Messenger approach has been used in confronting gun violence
and gang violence in communities in Chicago, from Phoenix to Philadelphia, and
from Baltimore to the Bronx. Two of the key elements that define this model are the
identification of perpetrators of violence and the transformation of their assump-
tions about violence, and the redefining of community norms relating to violence
through public education and messaging. The program’s integrity is built on the
community credibility of its Violence Interrupters, who are selected for their own
lived experiences with crime and violence. When implemented with high fidelity to
the original model developed by physician Gary Slutkin at the University of Illinois
at Chicago, results show that gun violence decreases [3].
Building on this model, who are the credible messengers who can help us iden-
tify persons at risk for human trafficking and disrupt and prevent human trafficking?
And what is the story we need to tell and the message we want to send?
The most obvious answer is that these credible messengers are the survivors of
human trafficking who walk among us – survivors who show victims of human traf-
ficking the path to survivorhood, recovery, and resilience. And indeed, these credi-
ble messengers are found within and throughout these pages. They are approximated
Preface xi
in the chapter case studies. Their insights spill onto the page in Chapter 19. And they
are found as co-authors on various other chapters. Some of these survivors have
chosen to reveal themselves as survivors. Still others write as their professional
personas or contribute anonymously and choose not to wear the title of survivor
just now.
All of us who encounter and serve victims and survivors of human trafficking –
“allies” if you will – serve as credible messengers to our professional communities.
We are the authors of this book and are also found within its pages. Likely we are
also the readers of this book. We take our own lived experiences to our colleagues:
our missed encounters, our botched attempts to help, our cowardice and fear, our
confusion and doubt, our courage in speaking up and showing up, our clarity, our
joy at seeing patients rise above their circumstances and break the cycle of human
trafficking.
Who will serve as credible messengers for the traffickers and exploiters and buy-
ers of humans?
And once we engage these credible messengers, what will the unifying message
be? Trauma beats us down, and in cases of complex trauma and trauma bonds, we
repeat the same story hoping against hope for a different outcome. But how do we
reframe the story? How do we tell the story differently? And by doing so, how do
we create a different story? How do we see and realize the world that could be in
spite of the way that it is?
We get different storytellers.
In this book, we hear from many different storytellers. We walk a fine line
between exploiting people for their stories and allowing survivors’ voices to be
heard. At times, we let data lead the narrative while we also acknowledge the need
for more data. We listen to the stories of complex trauma and survival and resil-
ience, we acknowledge our own blinders and biases, and we learn. And one by one,
block by block, and town by town, we change the narrative.
San Diego, CA, USA Kanani E. Titchen
References
1. Fresh Air [Internet]. Philadelphia: NPR; 2019. Ta-Nehisi Coates on Magic and Memory and
the Underground Railroad; 2019 September 24 [cited 2019 Oct 2]. Available from: https://
www.npr.org/templates/transcript/transcript.php?storyId=763477150
2. http://home2.nyc.gov/html/prob/html/messengering/cm_whatis.shtml Accessed Sep 26, 2019.
3. Butts JA, Roman CG, Bostwick L, Porter JR. Cure Violence: a public health model to reduce
gun violence. Annu Rev. Public Health. 2015 Mar 18;36:39–53.doi: https://doi.org/10.1146/
annurev-publhealth-031914-122,509.