Human trafficking is one of the world's fastest-growing crimes. It is not only in faraway places such as Thailand, China, Saudi Arabia, Cambodia and Russia — countries where we typically think of trafficking. Trafficking is happening in Georgia, Maine, Minnesota and Colorado. In fact, it is increasing at an alarming rate in all 50 states.

"The Catholic Health Association [CHA] is renewing its efforts to raise awareness among our members on the problem of human trafficking in this country," said Julie Trocchio, CHA senior director, community benefit and continuing care. "Particular attention will be given to educating clinicians in primary and emergency care. We will also help our members share best practices on contracting, investing and other policies and practices that can reduce human trafficking. For instance, Covenant Health Systems is among a number of systems that have influenced their group purchasing organization, Yankee Alliance, to place anti-labor trafficking language in their purchasing contracts. Catholic Health Initiatives has a wealth of information on its website to educate their communities on trafficking."

St. Mary's Health System in Lewiston, Maine, a member of Covenant Heath Systems, has sponsored the Lewiston-Auburn area's annual conference on trafficking and has provided guest speakers to share their expertise elsewhere in the Covenant system. In 2012, Tewksbury, Mass.-based Covenant adopted the battle against human trafficking as a focus of system-wide activities.

CHA has posted resources for the ministry about the effort to end human trafficking, including a series of networking conference calls, on this website at: www.chausa.org/human-trafficking.

"There is a global consciousness happening against human trafficking. CHA is part of the Coalition of Catholic Organizations against Human Trafficking with other ministries, including Catholic Charities, the USCCB [U.S. Conference of Catholic Bishops], Catholic Relief Services, LCWR [Leadership Conference of Women Religious], several religious orders and many other Catholic organizations," said Trocchio. "CHA's efforts are being called 'Faithfully United against Human Trafficking' and will encourage ministry activity through awareness, advocacy and action."

For over a decade, the USCCB has been a leader in the U.S. and global response to human trafficking. The U.S. bishops have established an anti-trafficking program within the Migration and Refugee Services Department to coordinate the response of the U.S. church. They caution us to be observant, and they offer some red flags to look for in possibly trafficked victims, including:

• Seem anxious, fearful or paranoid
• Avoid eye contact
• Tearfulness or signs of depression
• Unexplained bruises or cuts or other signs of physical abuse
• Appear to be in a relationship with someone who is dominating
• Never alone, or always have someone translating or answering questions on their behalf 
• Not in control of their own finances
• Present themselves with secrecy or are unable to answer questions about where they live 
• Inconsistent details when telling their story 
• Have no identification such as a license, passport or other ID documents
• Unable to leave their job or residence and cannot schedule their own appointments

The 2013 Catholic Health Assembly featured a session on human trafficking that included Wendy Macias-Konstantopoulos, MD, MPH, and Roy Ahn, MPH, ScD, both from Massachusetts General Hospital's Division of Global Health and Human Rights. The Boston-based hospital has launched a human trafficking initiative, and the panelists offered a list of questions health care providers can ask that may help identify a victim of trafficking:

• What type of work do you do?
• Are you being paid?
• How many hours do you work?
• Where do you sleep and eat?
• Do you live with or near your employer?
• Does your employer provide you housing?
• Are there locks on doors or windows from outside?
• Can you get out of your house when you want?
• Has your identification or documentation been taken away?
• Do you owe a debt to anyone?
• How did you get here (to the health care facility)?
• Where did you get your bruises?
• Is anyone hurting you or restricting your coming and going?

If the answers make you suspect the person is a trafficking victim, ask if you can help them find a safe place to go immediately — but remember, do nothing without the person's permission, advised Macias-Konstantopoulos.

With rare exception, if an adult patient over the age of 18 years is identified as a trafficked person, she said, it is extremely important to discuss potential next steps with that person before taking any action. Unlike suspected child abuse, suspected trafficking is not mandated to be reported to authorities, and health care providers should obtain the adult patient's permission before involving law enforcement. A trafficked individual — or his or her family and friends — could be in life-threatening danger, and the safety of everyone involved is of utmost importance.

Also, health care providers cannot act alone, she said. A trafficked person needs safety, housing, food and clothing, legal assistance, mental health care. It takes a great deal of collaboration across multiple disciplines to bring someone to safety and begin the process of healing body, mind and soul.

WHO IS MOST AT RISK?
There are many different types of human trafficking victims. Victims can be anyone, regardless of race, color, national origin, disability, religion, age, gender, sexual orientation, gender identity or citizenship status. While there is no defining characteristic that all victims share, traffickers frequently prey on individuals who are poor, vulnerable, living in an unsafe situation or who are in search of a better life. At high risk of being victims are those who have a history of substance abuse, were sexually or physically abused as children, are runaways or homeless youth and who have learning or physical disabilities.

Traffickers can be boyfriends, family members, acquaintances, peers, drug dealers, etc. Victims frequently are deceived by false promises of love, a good job or a stable life, and they are lured into situations where they are forced to work under deplorable conditions with little to no pay.

According to the Polaris Project (see Resources), there is at least one simple reason labor trafficking and sex trafficking persist and thrive: The risk is low and the profits are high.

When the community is unaware of this issue, when government and community institutions are not trained to respond, when there are ineffective or dormant laws to address the crime, when safety nets for victims do not exist and when law enforcement does not investigate and prosecute the crime, human traffickers perceive little risk or deterrence to affect their criminal operations.

When individuals are willing to buy commercial sex, they create a market and make it profitable for traffickers to sexually exploit children and adults. What's more, the Internet has added to the ease of selling sex and luring young victims.

When consumers are willing to buy goods and services from industries that rely on forced labor, they create a profit incentive for labor traffickers to maximize revenue with minimal production costs. For this, we must promote awareness in many ways. For example, you can become a more conscientious consumer by taking a quiz to check your slavery footprint (slaveryfootprint.org) and by reading the U.S. Department of Labor's report, List of Goods Produced by Child Labor or Forced Labor (www.dol.gov/ilab/programs/ocft/2012TVPRA.pdf).

You also can encourage companies you buy from to take steps to investigate and eliminate slavery and human trafficking in their supply chains and to publish the information for consumer awareness.

"Our ministry coming together will concentrate our voices in awareness, action and advocacy," said Trocchio. "Health care providers are possibly one of the few groups of professionals likely to interact with victims while they are still in their trafficking situation. Our frontline health providers may be in a position to intervene and help mitigate the effects of human trafficking. And it is part of the fabric of the Catholic health ministry to promote dignity, speak for those whose voices have been silenced, and we are called to promote the health and well-being of society."

NANCY MULVIHILL is vice president, corporate communications, Covenant Health Systems, Tewksbury, Mass.

RESOURCES

National Human Trafficking Resource Center
Hotline number: (888) 373-7888 or, text HELP or INFO to BeFree (233733)
The resource center answers hotline calls and texts from anywhere in the country, 24 hours a day, 7 days a week, every day of the year. Multilingual services are available. Call or text to ask for help; report a tip; connect with anti-trafficking services in a local area; request training and technical assistance; ask for general information or specific anti-trafficking resources. The center is part of the Polaris Project (see below).

Catholic Health Association, www.chausa.org/human-trafficking.

CNN Freedom Project: Ending Modern Day Slavery, http://thecnnfreedomproject.blogs.cnn.com/.

The Department of Homeland Security has an online training program on human trafficking awareness at www.dhs.gov/end-human-trafficking/.

ECPAT USA (End Child Prostitution and Trafficking), national policy organization against commercial sexual exploitation of children. Part of an international network of organizations. www.ecpatusa.org.

Free the Slaves, non-profit dedicated to ending slavery around the world. Freetheslaves.net.

Massachusetts General Hospital Human Trafficking Initiative: Groups interested in having expert faculty train health care workers can contact Roy Ahn, MD, ([email protected]) or visit www.mghglobalhealth.org.

Polaris Project, national organization combatting human trafficking and modern-day slavery. The group maintains the National Human Trafficking Resource Center hotline, provides services to victims, offers educational resources and training about trafficking and leads advocacy efforts for stronger federal and state laws. Its web site is www.polarisproject.org/.

United States Conference of Catholic

Bishops — www.usccb.org/issues-and-actionhuman-life-and-dignity/human-trafficking/.

WHAT IS IT?

Human trafficking is defined in the 2000 U.N. Trafficking Protocol as "the recruitment, transport, transfer, harboring or receipt of a person by such means as threat or use of force or other forms of coercion, of abduction, or fraud or deception for the purpose of exploitation." Whether made to work on a farm, in a factory, or at a strip club, forced into commercial sex or abused in a home as a domestic servant, federal law recognizes these people as victims of human trafficking.

The major forms of human trafficking include:

• Forced labor
• Bonded labor (debt bondage)
• Sex trafficking
• Involuntary domestic servitude
• Forced criminal activity
• Organ donations

Child trafficking includes:

• Forced labor
• Sex trafficking
• Child pornography
• Domestic labor
• Child soldiers
• Begging and peddling rings or sales crews
• Child laundering (illegal adoptions)
• Mail-order brides

HEALTH CLUES

In a health care setting, physical signs of a possible trafficking victim include:

• Physical injuries
• STDs and related diseases
• HIV
• HPV
• Chlamydia/gonorrhea /PID /infertility
• High risk and/or unwanted pregnancies
• Unsafe abortions
• Malnutrition
• Somaticized symptoms (chronic pain, headaches, gastrointestinal distress)
• Dental-related disease and/or injury
• Substance abuse (and related morbidities)
• Psychological disorders (anxiety, PTSD, depression, attempted suicide)