TMC PULSE

t m c » p u l s e | j u ly 2 0 1 7 28 Combating Human Tracking Clinicians can play a key role in Houston's war against sexual exploitation A t just 2 years old, Mari became a victim of sexual molestation. The perpetrator, her grandfather, continued to sexually abuse her for years. At 11, she ran away from home and met a man who promised her the world. Then he forced her into prostitution. For runaways and children of abuse, life can become an unforgiving cycle of commercial sex, trafficking and drug addiction. After a brief arrest, Mari—who asked that her real name be withheld for privacy reasons—worked hard to break free. But after her hus- band died, she tumbled back into the streets, working truck stops throughout the country and shooting herself numb with drugs to cope. Like many women forced into that world, she was only able to escape through incarceration. Today, Mari resides at Angela House, a local residential treatment program that helps women transition back into society after leaving the criminal justice system. The nonprofit works closely with Healthcare for the Homeless Houston, an organization that helps women with a history of sexual exploitation regain health and independent living skills through a program called Healthy & Whole. According to Andrea Link, M.D., pro- gram manager for Healthy & Whole and a clinical assistant professor with the Department of Family and Community Medicine at Baylor College of Medicine, a staggering 93 percent of the women at Angela House have a his- tory of sex trafficking or prostitution. Programs such as these are in high demand in Houston, considered a major hub for all forms of trafficking due to the intercontinental airport, major water port, international border and sprawl across the I-10 corridor. Statistics released by the National Human Trafficking Hotline show that Texas is responsible for the second- highest number of calls in the country— California is first—and the majority come from Houston. While in captivity, many of these victims seek medical help. At war A study by the Family Violence Protection Fund found that nearly B y A l e x a n d r a B e c k e r ... essentially the trafficker tries to depersonalize the victim. Why was this person, this so-called boyfriend's name, tattooed backward on her chest? Because the first thing she would see in the morning when she looked in the mirror was his name. — REENA ISAAC, M.D. Medical director of the forensic nursing team at Texas Children's Hospital O ften described as a modern-day form of slavery, trafficking is the coer- cion of human beings for the purpose of forced labor or sexual exploita- tion. Trafficking does not have to involve the physical movement of a person, and traffickers in the United States prey on U.S. citizens more than interna- tional or illegal residents. The average age of a child recruited or forced into prostitution is 11 to 14 years old. An estimated 600 children and adolescents are victims of forced sexual acts every night in the state of Texas. Common risk factors associated with falling victim to sex trafficking include a history of sexual abuse or substance abuse, disability, mental illness, and unfamiliarity with the local language or surroundings. one-third of trafficking survivors had been seen by a health care provider during their time in captivity, for rea- sons including unwanted pregnancies, STDs, drug-related conditions and other circumstances associated with abuse. Additional studies estimate even higher numbers. "Emergency departments are often easy places for a lot of these victims to go because they can be anonymous," said Reena Isaac, M.D., medical director of the forensic nursing team at Texas Children's Hospital. Yet as many as half of these individuals were not identified as victims of exploitation during their clinical experience. "What is needed is not only more resources, but I would also argue train- ing—for the individuals who we know are going to come into contact with traf- ficking victims," said Lisa Muftic, Ph.D., director of the undergraduate criminal justice and criminology programs at Sam Houston State University, during a recent forum on human trafficking in Houston. "We know this has been very beneficial and very effective in law enforcement and believe that the same would be true in the health care arena." Clinicians are in a unique position to break the cycle for victims by con- necting them to appropriate care and rehabilitation services. But first, they must recognize the signs associated with trafficking. Malnutrition, dehydration, drug abuse, skin infections and physical inju- ries in various stages of healing, includ- ing bruises, broken bones, cuts and burns are considered red flags. Victims also often report a high number of sexual partners or may have exposure to HIV and other STDs, fertility issues, genital trauma, multiple unwanted pregnancies, UTIs, and mental health issues, including symptoms of post-traumatic stress disorder (PTSD). A Vicious Cycle

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