Hanni Stoklosa, MD, MPH, of the Department of Emergency Medicine, is a nationally recognized expert in caring for patients affected by human trafficking. A decade ago, she co-founded HEAL Trafficking, a collaborative with a mission to end human trafficking and support survivors through public health approaches. This year, Stoklosa and co-authors evaluated a HEAL toolkit with best clinical practices to care for trafficked persons, in an article published in the Journal of Human Trafficking. In this Q&A, Stoklosa shares her motivations for addressing horrific crimes in society and offers specific examples of patient care protocols for survivors of human trafficking.
Q: How did you become interested in studying and preventing human trafficking?
I grew up in a home of faith so the need for one’s life to be dedicated to fighting injustice is integrated into my DNA. In medical school, I chose the path of emergency medicine because I was drawn to the cases with highest acuity that were literally life or death. This plays out both in my clinical world and in the cause I have dedicated my life to: ending human trafficking. Exploiting someone’s labor for one’s profit is the ultimate form of horrific violence and injustice. It hurts people around the globe, especially the most marginalized.
Q: Can you tell us about HEAL Trafficking and how it informs your research?
I co-founded HEAL Trafficking ten years ago at a time when few people in health care were talking about trafficking. Our co-founding group believed the health sector has an opportunity and responsibility to respond to trafficking and that public health approaches are needed to prevent trafficking from happening in the first place. After seeing those gaps, we started HEAL Trafficking to respond to trafficking, equip health professionals and health systems to respond to trafficking, and shift the conversation happening around limited criminal justice measures to holistic public health reforms instead. Today, HEAL Trafficking is comprised of over 4,000 health professionals and survivors of trafficking worldwide who have taught me so much and inform my clinical practice as well as research.
Q: Why do health settings need to have human trafficking response protocols?
First, we know most trafficking victims have at least one, if not multiple touchpoints with health care while they are being trafficked.
I cannot overstate how important it is for health systems to have guidelines in place for trafficking response. Let me give an example: Imagine a victim of trafficking is brought to an emergency department on Saturday at 2:00 a.m. They were in a car accident. The nurse notices they do not seem like just any other patient who has been in a car accident. Maybe there is a controlling person in the room who is not really letting them talk, or they are being evasive about the details around the accident. Despite how bad the accident was, no one called 911 and they were brought in via private vehicle. The nurse has the training to notice the signs that indicate this patient could potentially be experiencing exploitation, such as trafficking. This may be the only contact the trafficking victim has with people outside of their situation to receive help. But now what? If a trafficking plan that works on any given Saturday at 2:00 a.m. is not in place, we will miss critical opportunities to intervene in victims’ cycles of violence.
Q: Can you tell us about key recommendations you developed in the toolkit for human trafficking response protocols?
We need to change how we assess patients for experiences of violence, including trafficking. Counterintuitively, the goal is not for disclosure or rescue, but rather to plant seeds and allow the patient to guide the conversation and its outcomes. The way I was trained was like most clinicians. I was trained to think screening for violence – for child abuse, domestic violence or trafficking – was going down a list of yes or no questions. If you think about it, that approach doesn’t make sense. If you are a patient who is afraid, or feels shame about what has happened to you, you’re thinking to yourself, “Why would I share anything with this clinician? If I do tell this person, will things change for the better or worse?”
Rather than a checklist, we recommend a structured conversation where the goal is to empower patients with information. We advocate for the PEARR approach: privacy, educate, ask, and then respect and respond. First, find a private place to talk with the patient. Returning to the example earlier, because there was a person accompanying the patient, maybe the nurse talks to them when they are getting X-rays in radiology. Once alone, the nurse might say something like, “I am your nurse and I care about your health and your safety. Some patients in our emergency department are in situations where they are afraid and they feel like they can’t leave, maybe because somebody is profiting off them or threatening them or their family. I do not know what is happening to you, and I want you to know this is a safe place and we have resources to help people in these situations. If you want, I can share more.” The patient guides the remaining conversation, and regardless of where that leads, the nurse respects the patient’s decisions. Each step of PEARR flips the script: the control needs to be in the patient’s hands as opposed to the clinician’s.
Q: What are some future directions HEAL Trafficking’s work will take?
There have been legislative developments that have come out of us creating these foundational resources for health systems. The state of New York has mandated that diagnostic centers, which includes all hospitals, have trafficking plans in place. We would love to see more states adopt such laws.
Our toolkit is being used in over 50 countries globally and implemented in a range of hospitals, from large systems like Mass General Brigham to a critical access hospital in Montana. We continue to expand the depth and breadth of our work with health systems globally. For example, we are working with the public health system in Brazil to adapt, embed and integrate the toolkit into their public medical system.
Q: Any final thoughts for Brigham staff and clinicians?
Each of us can make a difference in the effort to end human trafficking. Educate yourself on the issue by checking out the resources on HEALtrafficking.org. How you do your work everyday matters.