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“An ounce of cocaine, wholesale, $1,200. But you can only sell it once. A woman or a child, $50 to $1,000, but you can sell them each day, every day, over and over and over again. The markup is immeasurable.” This is an excerpt from the TV miniseries, “Human Trafficking,” which aired on the Lifetime channel in October, 2005.
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Nestled in the Columbus, Ohio, North Library is a quaint café serving made-from-scratch snacks and lattes. This idyllic locale caters primarily to the students of Ohio State University and residents of the surrounding neighborhood. What makes this business unique is that it also serves up hope to many survivors of human trafficking through new job skills and a sense of community.
Freedom Ala Cart, partnering with Catch Court, offers the first program of its kind in the country. Of the 1,200 people arrested last year for solicitation in the Columbus area, 92% identified themselves as victims of sex trafficking. Catch Court provides an option for victims of human trafficking, prostitution, and sexual exploitation by providing resources, community, and accountability. The program seems to be working because 85% of those who complete the program have faced no new criminal charges.
The U.S. Victims of Trafficking and Violence Protection Act of 2000 defines human trafficking as, “A commercial sex act in which the person induced to perform such an act is younger than 18 years or (can include) the recruitment, harboring, transportation, provision, or obtaining of a person for labor or services, through the use of force, fraud, or coercion, for the purpose of subjection to involuntary servitude, peonage, debt bondage, or slavery.”1
It may surprise some that despite its wholesome reputation, Ohio is fifth in the nation for trafficking. This is important to note because trafficking exists in even the most unassuming places. The problem is not unique to Ohio. In the US it is estimated that the number of victims reaches into the hundreds of thousands. The national trafficking hotline receives an average of 100 calls per day from all 50 states. Globally, sex trafficking is a $150 billion industry. Of the 21 million victims of human trafficking, 26% are children, 55% are women and girls, and the numbers are climbing.
Trafficking and dental professionals
So, you’re probably wondering, “What does this have to do with dental practices?” To begin, there is a professional and legal obligation for dental professionals to be aware of any signs related to abuse in their patients. According to the American Dental Association Principles of Ethics and Code of Professional Conduct, the dentist is “obliged to become familiar with the signs of abuse and neglect and to report suspected cases to the proper authorities consistent with state laws.” Such a professional responsibility becomes paramount when one considers that an estimated 26% of individuals subjected to human trafficking are minors. Therefore, dental professionals are required to report suspected abuse in their roles as mandatory reporters.
Additionally, should the dental professional have an adult patient someone suspects could be the victim of human trafficking, it is beneficial to the patient that his or her chart contain a record of any suspicious injuries. Such a record could be subpoenaed by the patient should the person want to press charges against the captor. The detailed documentation of suspected physical signs of abuse and neglect could serve as an invaluable resource for the patient and prosecution.
Dental professionals should look for and document the following indicators of human trafficking should they present in patients:
• They’re not in control of their own IDs or insurance cards.
• They’re not allowed or able to speak for themselves. A third party insists on being present and translating.
• They claim to be visiting a friend or relative and they’re unable to clarify where they’re staying.
• They do not know what city they’re in.
• They’re unsure what day, month, or year it is.
• They have numerous inconsistencies in their stories.
• They appear malnourished.
• They show signs of physical or sexual abuse, physical restraint, confinement, or torture.
According to one recent report, an estimated 28% of victims of human trafficking have come into contact with a health-care provider while being held captive. This report mentions that in such cases, health-care providers seem to have missed the critical signs that indicate captivity and thus did not intervene. Couple this with the suspected number of human trafficking individuals and it becomes very likely that dental professionals will see patients who are being trafficked.
The entire dental team should be aware of the signs associated with human trafficking. Dental assistants and hygienists often have regular contact with patients, perhaps even more so than a general practitioner. Dental assistants are particularly well positioned to notice patterns of suspected abuse and neglect because they’re typically involved with the care of patients over the course of time and in a consistent manner. As a constant presence during the course of care, dental assistants have the valuable opportunity to establish and maintain trust with patients, and this trust fosters the patient’s likelihood to disclose any abuse and neglect.
Dental practices should develop a strategy for managing suspected cases of human trafficking to include methods for asking appropriate standard questions should abuse and neglect be suspected. These can include, “Do you have the ability to change jobs if you want to?” “Has anyone ever forced you to engage in work you did not want to do?” and “Do you feel safe at home and in your personal relationships?”
Dental teams should be aware of the physical and psychological impacts associated with abuse that could impact how they deliver care. Such patients may experience post-traumatic stress disorder, anxiety, and depression. These symptoms can impact the provision of care from how patients prefer to be positioned in the chair, how they feel about items placed in their mouth, or if they perceive a feeling of being out of control during treatment. Therefore, it is essential to communicate with them throughout the appointment in order to determine how to deliver care so that they’re comfortable and feel a sense of personal control.
Dental practices should have protocols for mandatory reporting, and these should be created in conjunction with state laws. It is also advised that dental practices contact local law enforcement for guidance regarding how to report suspected cases of human trafficking. State dental boards may serve as resources as more acknowledge the important role dental professionals play in assisting victims and survivors of human trafficking.
Offices should try to employ strategies that ensure patients can be seen alone in the operatory without their possible captor. This allows them the opportunity to speak freely. Dental practices should keep brochures about helpful agencies easily accessible to patients, as well as information regarding their rights under US law. Information should be kept in private areas, such as the operatory and restroom, as well as public areas, such as patient waiting rooms. The National Human Trafficking hotline at [(888) 373-7888] can be a good source of information for patients and dental professionals.
It’s important to know that evidence of trafficking might be obvious, but a patient might refuse assistance. This can be from fear but also because someone may not see their relationship with their captor as abnormal, or may even see it as providing security. Dental health-care professionals can make a difference by being consistent, documenting suspected trafficking activity, being aware of the signs that someone may need assistance, and having a plan if someone approaches them for help.
Karen K. Daw, MBA, received her bachelor’s degree from Ohio State University. After graduation she stayed on at OSU as the assistant director for the sterilization monitoring service and then as the Clinic Health and Safety Director for the OSU College of Dentistry. She cearned an MBA with a focus on Management and Healthcare Administration, applying principles of lean processes to safety in the dental field. Ms. Daw is an authorized OSHA trainer with 20 years of experience as a writer, speaker, and consultant.
Jessie Tudor-Tangeman, PhD, is the office manager and the assistant to the Chair of Biosciences at Ohio State University. She is a graduate of Franklin University, and obtained a BS in employee assistance counseling, a BS in human resource management, a MS in human services management, and a MBA with a leadership focus. Dr. Tudor-Tangeman is also a graduate of Walden University, with an MS and PhD in public health with a focus on community health education. Dr. Tudor-Tangeman is certified in suicide prevention and crisis intervention.
Authors' note: We referenced the following websites for our research while preparing this article:
https://www.ncbi.nlm.nih.gov/pubmed/22547722
Reference
1. U.S. Victims of Trafficking and Violence Protection Act of 2000. https://www.state.gov/j/tip/laws/61124.htm. Published October 28, 2000. Accessed April 16, 2018.
