Human trafficking, a public health crisis exacerbated by a global pandemic: What is the nurse’s response?

In the context of a global pandemic, vulnerability has only increased for those already at highest risk for victimization by human trafficking. Lockdowns, travel restrictions, and economic stagnation have left victims of human trafficking with limited hope of escape. Agencies that provide aid to these victims have been unable to operate at normal capacity. And with less potential to interface with the public, victims of human trafficking are harder to identify and harder to assist. Without a doubt these victims are also disproportionately at a risk for contracting Covid-19 and a host of other healthcare related concerns, most commonly STIs, substance abuse, mental and physical abuse, and nutritional deficits.

While human trafficking victims can be difficult to identify in the general public, these individuals can be more readily identified in healthcare settings. It is estimated that 50–80% of victims of human trafficking are seen by a healthcare provider while under the control of their trafficker (Byrne, Parsh, Parsh, 2019). Nurses hold a special responsibility to screen patients for possible signs of victimization due to the high amount of one-on-one time they spend with patients relative to other providers. Screenings should include monitoring for mood swings, high states of anxiety, emotional outbursts, self-loathing, or substance abuse. Signs of physical abuse (e.g., bruises, burns, bald patches, malnourishment) and tattoos that resemble “branding” should also be addressed. Stories provided by victims of human trafficking might include inconsistencies as victims might lose track of place and time or have clouded memories due to abusive situations. When screening patients for signs of victimization by human trafficking, nurses should strive to create a bond of trust and always try to speak to a patient alone—as patients are often accompanied by a trafficker that will not allow the patient to freely respond to questions.

Now more than ever, nurses and other frontline healthcare workers need to be made aware of a growing public health crisis—that of human trafficking. Readily screening patients about their safety at home and at work is imperative. With this in mind, nursing programs should aim to include the topic of human trafficking in their curriculum.

My university recently had the opportunity to partner with a local non-profit agency, Jasmine Road, that offers a residential rehabilitation program for victims of human trafficking. In the virtual two-hour simulation written by survivors of human trafficking, the students assumed the role of a teenager who finds herself homeless, jobless and fighting for survival. Throughout the simulation, students made “choices” of where to live and work. The challenge was that the choices were very limited, i.e., an overcrowded shelter, a rundown hotel known for prostitution, the streets, or the home of an abusive boyfriend with a drug addiction. Through the vivid descriptions provided in the simulation, students became acquainted with the cycles of poverty and abuse that keep human trafficking victims stuck in dangerous situations and often debilitating relationships. At the conclusion of the simulation, students overwhelmingly stated that they had not been aware of the scope of human trafficking as a public health issue, and they were not previously aware of the painfully limited choices available to victims of human trafficking.

This simulation was an example of a way to leverage community partnerships to provide nursing students with relevant and impactful learning experiences. This partnership was cultivated after identifying the need for nursing students to be familiar with human trafficking as a concept and the need for students to screen patients for signs of victimization by human trafficking. When nursing students enter professional practice with this knowledge and these skills, they will be best prepared to positively impact community health as it relates to human trafficking. When this learning occurs in a simulation environment, it can also provide a valuable opportunity for students to move beyond concepts by hearing, feeling, and debriefing about a patient’s experience of human trafficking.