How doctors can help stop human trafficking while treating Covid

Hanni Stoklosa, MD, MPH is an emergency physician at Brigham and Women's Hospital, in Boston, Massachusetts, with appointments at Harvard Medical School and the Harvard Humanitarian Initiative. She is the co-founder and chief executive officer of HEAL Trafficking and serves on the steering committee of the Alliance to End Slavery and Trafficking. The opinions expressed in this commentary are solely those of the author.

(CNN)As a Boston emergency medicine physician, I've heard this sentence from innumerable patients: "I am afraid I have Covid." I heard it this month from a Spanish-speaking home health care worker. She had a fever, body aches, stuffy nose, and a sore throat -- and was curled up on the gurney with a blanket wrapped tightly around her shivering body.

But she wasn't just a textbook picture of someone with Covid, she also had the classic characteristics of someone vulnerable to human trafficking.
As Omicron races across the globe and hospitals teem with infected people, emergency rooms may also be filling up with people vulnerable to another epidemic: human trafficking. The Omicron surge presents a unique opportunity to do something about it. For people experiencing human trafficking, Covid testing, vaccination, and treatment may mark their only outside interaction with individuals who could enable them to access help and freedom.
    Dr. Hanni Stoklosa
    At any given time, it is estimated there are 24.9 million people in forced labor globally and we know many trafficking victims access healthcare.
      Human traffickers prey on people in vulnerable groups such as migrants, people of color, or those with disabilities. Traffickers tend to exploit people in low-wage sectors like nannying, house cleaning, landscaping, agriculture, fishing, commercial sex work, and home health services. Through a mixture of manipulation, threats, violence and debt, traffickers trap their victims in lives of servitude. There is no one sign that someone is trafficked, and the first clue is often the type of work they do. They may have injuries related to their work, be more fearful than I would suspect for the circumstances, or have no idea how they got to my hospital.
        Throughout the pandemic, trafficked people were forced to keep working despite limited access to personal protective equipment. Many got Covid and some died.

        A missed opportunity

          During the Delta surge, the medical community missed a huge opportunity that we should not repeat. Because many trafficked individuals are often considered essential workers, they may be prioritized for Covid testing and vaccination. I urge all health care workers to seize the opportunity to assess their patients for human trafficking.
          It may seem heretical to suggest adding more to the plate of clinicians who are drowning and systems that are bursting at the seams. Yes, I do see the National Guard in my emergency department, a stark reminder of how thin the healthcare workforce is stretched. Like so many of my colleagues, I am body and soul tired. My face hurts from the etchings of the N95 mask that I am afraid to take off during shift, even for a sip of water.
          And yet, despite the teeming waiting room, when I encounter patients with telltale characteristics of vulnerability to trafficking, I pull up a stool, look my patient in the eyes and open the conversation.
          "As your doctor I care about your health. And I believe your health is related to the work you do. Some of my patients are in situations where their boss is controlling them, maybe threatening them or their family, holding onto their documents, not paying them. Has that ever happened to anyone you know or to you? I ask because I care about you, and we have resources to help people when they're trapped in situations like that."
          Over the years patients have responded in many ways to my trafficking inquiry. Some disclose their trafficking situation and say, "I was praying for someone to ask me a question!" Others say, "Thank you, I will share this information with my community!" They are universally grateful.
          I see each of these conversations about exploitation with my patients as planting seeds. Perhaps that patient will tell someone in her community about the fact that they have rights, or that my emergency department is a safe place to get help. Perhaps the next patient will ask for help. It is not my job to know when those seeds will sprout, just to plant them.

          Making a difference

          February is on track for Covid to continue to pummel country after country. Health care professionals have an opportunity and responsibility to be ready to respond to those experiencing trafficking who may only visit us during this brief window of time.
          Simple interventions can make a big difference. It doesn't have to take long. It doesn't have to be complicated. Health professionals can ask simple questions about work and exploitation in the privacy of a Covid-precautions room.
            But it's not just doctors and health care workers who can make a difference. Everyone else can learn the warning signs and how to refer people for help.
            As Omicron brings trafficking victims out of the woodwork, let us all be ready to plant seeds of freedom.