TMC PULSE

t m c » p u l s e | j u ly 2 0 1 7 29 Mari, a victim of sex trafficking, now resides at Angela House, a residential treatment program to help women transition back into society after leaving the criminal justice system. "Studies have shown that PTSD rates in women who have been prosti- tuted on the streets are similar to that of combat-exposed Vietnam veterans," Link said. "When we tell the women this, the relief on their faces is incred- ible. Because they have been at war. I think a lot of people haven't recognized that. But trust me, they've been at war." Unusual tattoo Other patterns observed among vic- tims of sex trafficking include scripted answers or inconsistencies in stories about their illness or injury. Their traffickers often accompany them to medical appointments, speaking for them as much as possible. "Another thing to look out for is simply fear," said Juhi Jain, M.D., pediatric resident at Baylor College of Medicine and a chair of the anti-human trafficking committee within Doctors for Change, a Houston-based organiza- tion that advocates for improvements in health care by connecting medical providers to the public health and pol- icy arena. "They're not able to look you in the eye, or they're not able to tell you their story. And if they do, they don't tell you exactly what's happening." Sometimes, the red flags are staring doctors in the face. Certain tattoos with branding designs and bar code images, for example, serve as physical manifes- tations of the traffickers' ownership and power over victims. It was exactly that—an unusual tattoo—that clued Isaac into a patient's story a few years ago. A teenage girl had come in with a fairly minor complaint, but during the examination Isaac noticed the name of the girl's "boyfriend" tattooed backwards in large letters across her chest. "That's a very curious sign," Isaac recalled. "If you understand the psy- chology of both the trafficker and some of the victims, essentially the trafficker tries to depersonalize the victim. Why was this person, this so-called boy- friend's name, tattooed backwards on her chest? Because the first thing she would see in the morning when she looked in the mirror was his name." Isaac was able to help rescue this patient from her situation because she knew the signs and, most importantly, asked the right questions. In fact, a study by the Vera Institute of Justice found that trained health care providers can identify 60 to 80 percent of human trafficking victims by simply asking two questions: Where do you live? What do you do for work? "Everyone should be able to tell you where they live or what their job is, and if they have a hard time describing that, or if they tell you something that doesn't sound right, then you delve in deeper and things start to come out," Jain explained. Additional screening questions might be: Is anyone forcing you to do anything you do not want to do? Can you leave your job or situation if you want? Have you or your family been threatened if you try to leave? One of the most critical and challenging actions a clinician can take is separating the patient from whomever is accompanying him or her at the time of the visit. "You want to be able to have a confidential and secure conversation," Isaac said. "Be sure to convey care and concern, keep an open dialogue and show patients respect and patience." According to Mari, establishing trust with trafficking victims is a critical step in helping them. (continued) Individuals from abusive homes or impoverished situations may be lured by a trafficker's affection or promise of a better life, and runaways often welcome a trafficker's offer of food and shelter. According to National Incidence Studies of Missing, Abducted, Runaway, and Throwaway Children, an estimated one out of every three minors who run away is lured into sex trafficking within 48 hours of leaving home. Victims are recruited through physical contact—on the street, in shopping malls—or, increasingly, via the internet. Advances in technology have granted traffickers more access and increased their methods of exploitation. A recent local Facebook post recounted the story of a young girl who was taped without her knowledge during a sexual encounter with her boyfriend; unbeknownst to her, he was caught up in a sex trafficking ring. His accomplices threatened to post the video on social media if she did not comply with their demands and the girl, humiliated and scared, was reportedly forced into prostitution. Booked through online websites like Backpage, her traffickers eventually told her she could work less if she recruited others. It's a vicious cycle that exploits an individual's vulnerabilities. Traffickers place victims in their debt by requiring quotas and demanding long work hours. Through threats, drug or alcohol dependency, isolation and physical abuse, they make victims feel like it is impossible to escape.

• Cover