Human trafficking refers to situations of forced labor and/or sexual servitude. At any given time, millions of individuals are trafficked worldwide. It is estimated that up to 17,500 individuals are trafficked into the United States annually; more than 20% are involved in sexual trafficking. Survivors of human trafficking are victims of psychological, physical, and sexual abuse that leave them vulnerable to a variety of medical conditions. Moreover, these patients are often fearful, distrust medical providers, and may resist attempts to evaluate them.
In May 2012, an article published in Obstetrics & Gynecology (Obstet Gynecol 2012;119:1045) called for action by obstetrician-gynecologists and other health care providers to address the health-delivery needs of victims of human trafficking. In response to this call to action, the “Hope Through Health Clinic With Community Care,” was created in Central Texas as a multidisciplinary medical home for human trafficking survivors. The opening of this facility in 2013 was the culmination of the joint efforts of several institutions part of the University of Texas System (including the Southwestern Obstetrics and Gynecology Department, Schools of Social Work and Nursing) as well as local social agencies. The information in this commentary is presented to educate health care providers on the medical and nonmedical needs of human trafficking survivors and to provide suggested steps for organizing similar multidisciplinary medical homes in other states.
Working with survivors of trafficking requires the multidisciplinary, collaborative effort of professionals trained about human trafficking and trauma-informed care (which refers to patient-centered care provided with awareness of effect of trauma on health and behavioral decisions). Family medicine and obstetrics-gynecology providers as well as all other members of the care team received training on trafficking and trauma-informed care through a course offered by Refugee Services of Texas. A total of 33 patients have been seen since its inception for total of 71 visits. Most patients (78%) were women and Spanish speaking (72%) and had histories of both sex and labor trafficking; their average age was 28 years. The single most common complaint reported by 39% of patients was depression. Other medical issues included contraception, treatment for sexually transmitted disease, dyspareunia, chronic pelvic pain, and female genital mutilation. Initially, social workers/case managers saw the patients to address pressing nonmedical needs, including housing, acquiring jobs, receiving legal services, basic food, clothing, and transportation. The physician met with the social worker before seeing patients to discuss their individual needs and history of trafficking; this avoids asking the patient redundant questions about these sensitive topics.
The development phase for the clinic lasted 2 years providing time for clinic systems and services to be optimally organized. Both patients and referring agencies should have realistic expectations of what the clinic can provide and who is eligible for its services. Local community and organizational support were available to help in the development of the clinic. Its survival will depend on how many patients can be identified and referred for its services. Research is needed to determine both the long-term health effect of trafficking on patients and whether the proposed trauma-informed medical home can improve health outcomes.