Barbara Glickstein “I freed a thousand slaves. I could have freed a thousand more if only they knew they were slaves.” —Harriet Ross Tubman, nurse abolitionist Human trafficking is a serious crime of forced labor or enslavement. It is also a human rights tragedy. And it happens more often than we might think. The International Labour Organization (ILO) estimates that 12.3 million people are held as slaves around the world, representing a profit to the abusers of $32 billion and an additional loss to the victims of $20 billion (ILO, 2009). Many nurses have treated victims of human trafficking without realizing it. Encountering modern-day slavery can provoke a strong visceral response, often followed by the urge to distance ourselves from it. These feelings make it hard to imagine what you, one nurse, could possibly do to stop it. However, nurses are uniquely situated to make a difference. When I speak about trafficking, nurses often approach me to discuss whether they may have cared for a person who was trafficked. One nurse told me she was a maternal child health nurse and worked at a community clinic. Once, a young woman presented in her final month of pregnancy but had no prenatal care, ID, or legal documents. She was accompanied by a man who was controlling and did most of the talking for the young woman, who introduced him as her “friend.” The nurse who spoke with me had cared for domestic violence victims, but this felt different to her. Her skillful attempts to remove the male companion for part of the examination were met with resistance, but her persistence provided a few moments alone with the patient. However, the young woman repeated the same exact story, almost line by line, that she told in front of her male companion. The nurse knew that it would take time to learn the real story behind this patient and hoped there would be another chance on the next visit. There was no other encounter. Was she a victim of human trafficking? There is no way to know. Nurses should ask themselves one question: “What role can nurses have in stopping human trafficking?” This question leads to the following important questions: There are more than 13 million nurses worldwide providing up to 80% of the health services in most countries (International Council of Nurses, 2010). In every community where a nurse provides care, there are people who are vulnerable and could be targeted by traffickers. A trafficked person may be referred to a health care provider; a patient may disclose a trafficking experience; or a provider may detect signs that suggest an individual has been trafficked. To provide the best service to victims, it is imperative that nurses be aware of trafficking, be skilled in screening people who may be trafficked, and understand the needs of victims. Nurses can help to end trafficking by educating the public about this travesty and creating policies to protect those who are trafficked. Nurses are also at risk for being trafficked. As poorer nations prepare nurses for export to other countries, questionable recruiting practices have led some migrating nurses to be threatened with criminal charges and deportation when they object to exploitative working conditions. Raising nurses’ awareness about human trafficking can lower their own risk. Anthropologist David Feingold says, “Trafficking is like a disease. If you don’t change your response or if your response to the disease is 10 years out of date and made up of myths, the solution will not be effective, and may even be harmful” (Silverman, 2003). The following are four major myths about human trafficking: 1. Human trafficking is just an international problem. 2. Poverty and inequality are the causes of human trafficking. 3. Trafficking occurs only for the sex trade. 4. People who are traffickers have a common stereotypical profile. The reality is that human trafficking occurs in almost every country including the United States—the second most frequent destination for trafficked persons. The U.S. State Department estimates that 15,000 victims enter the U.S. each year through trafficking rings, and that more victims are trafficked within our borders (U.S. Agency for International Development [USAID], 2004). These numbers are estimates because the trade is secretive, the victims are silenced, and the traffickers are dangerous. Although the majority of people trafficked are women and girls into sexual servitude, trafficking is not just forced prostitution. Victims of human trafficking may also be in forced labor situations as domestic servants (nannies, housekeepers, maids); sweatshop workers; janitors; restaurant workers; migrant farmworkers; fishery workers; hotel or tourist industry workers; or workers in nail salons. Without recruiters and criminals, human trafficking would not exist. Poverty, unemployment, inflation, war, and the lack of a promising future are compelling factors that facilitate the ease with which traffickers recruit people, but they are not the cause of trafficking. Traffickers take advantage of poverty, unemployment, and the desire to emigrate to recruit people and traffic them into dangerous situations. Tragically, recruiters often know their victims. A common way that many victims are recruited is through a friend or acquaintance (e.g., a cousin, neighbor, boyfriend, or fiancé) or by an individual recommended to them by someone they trusted. Sometimes victims are recruited in groups. For example, an agency sets up a booth at a job fair in a high school gym. The legitimate-looking pamphlets, websites, and recruiters are quite professional looking. When victims arrive in a destination country, the methods used to control them include confiscation of travel documents, violence, threats to harm family members, and debt bondage. Whatever the recruitment method, the majority of people do not expect the exploitation and violence that awaits them. The ugly truth is that trafficking is big business. Traffickers make large profits due to high demand at low risk of prosecution. Finally, traffickers can be anyone. Traffickers brazenly operate in our neighborhoods. They advertise in our newspapers and on Craigslist. They are men and women of all ages. They run legal employment agencies. They are diplomats who often get diplomatic immunity when caught, and they work in all kinds of professions (General Accounting Office, 2008). They act alone, or they may be members of international crime rings. For nurses, trafficking in persons (TIP) can be best understood as a very serious health risk, because trafficking, like other forms of violence, is associated with physical and psychological harm (International Organization on Migration, 2009). It has serious public health implications related to the spread of infectious diseases such as tuberculosis, HIV, and other sexually transmitted diseases. Victims of trafficking are highly prone to social, economic, and legal issues that further put them at risk for a variety of mental health issues, including substance abuse, addiction, anxiety, depression, and even suicide (Hynes & Raymond, 2002). Common abuses experienced by trafficked persons include rape, torture, and other forms of physical, sexual, and psychological violence (Zimmerman, Hossain, Yun, Gajdadziev, & Guzun, 2008). Those who are sexually exploited may have multiple forced abortions, acquire sexually transmitted diseases, and experience other physical and psychological health problems (Moynihan, 2006). Paradoxically, these victims who desperately require health services are less likely to have access due to discrimination, social stigma, fear of law enforcement, and other factors. Nurses can contribute their expertise by conducting research on human trafficking as a global public health issue (Boxes 104-1 and 104-2). BOX 104-1 What Can You Do about Human Trafficking?
Human Trafficking
The Need for Nursing Advocacy
The Myths
Trafficking as a Global Public Health Issue
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Human Trafficking: The Need for Nursing Advocacy
