Month: January 2018

Categories
General Public Health

Human Trafficking: A Brief Guide for Physicians

Human trafficking. Like many things we hear about or read in the news, it seems like a problem of developing countries like Cambodia and Thailand. However, what we fail to realize is that human trafficking, also known as modern slavery, is alive and well within the United States and affects children and adults across all socioeconomic statuses. A harrowing fact is that up to 85% of people forced into human trafficking saw a physician at some point and more than 60% had at least one ER visit1. However, most physicians have not been trained on how to identify and help patients who are potential victims of human trafficking2. This article will hopefully provide more insight into what human trafficking is, how to identify a victim, and most importantly, how to help them.

The State Department of the United States indicates that human trafficking consists of domestic servitude, forced labor, debt bondage, as well as sexual exploitation3. While these are different types of human trafficking, warning signs that a potential patient is a victim to these crimes tend to be very similar. The U.S. Department of Education has provided some common identifiers for physicians in all states to be aware of, including a patient who:

  • Makes references to frequent travel to other cities or towns
  • Exhibits bruises or other signs of physical trauma, withdrawn behavior, depression, anxiety, or fear
  • Lacks control over her or his schedule and/or identification or travel documents
  • Is hungry, malnourished, or inappropriately dressed (based on weather conditions or surroundings)
  • Shows signs of drug addiction4

Victims are often in attendance with their abuser, whether this is a pimp or “employer”, so it is important to speak to the patient alone to elicit a thorough history and help the victim. An excellent resource for all health care professionals in the emergency room is a phone app called “Sex Traff”5. It is designed by two physicians with the intent of helping health care professionals identify potential victims of sex trafficking using a simple screening questionnaire.

As the awareness of human trafficking increases, there is also an increase in health professional training sessions available in several cities across the nation, as well as online training available through the national human trafficking hotline: https://humantraffickinghotline.org/material-type/online-trainings. It is important that healthcare providers of all ranks be informed of this pervasive problem, as well as how to respond. Please share this information with your staff and colleagues, so that we can do our part to combat human trafficking.

Source(s):

1https://wire.ama-assn.org/delivering-care/how-physicians-can-identify-assist-human-trafficking-victims

2https://www.reuters.com/article/us-sex-trafficking-recognition/doctors-not-trained-to-spot-sex-trafficking-victims-idUSKBN0MC1XE20150316

3 https://www.state.gov/j/tip/what/index.htm

4https://www2.ed.gov/about/offices/list/oese/oshs/factsheet.html

5 https://play.google.com/store/apps/details?id=com.ncpl.sextraff

Photo Credit: Thomas Wanhoff Source: Flickr

Categories
General Lifestyle Reflection

Running

For just split seconds, I am floating, flying, feeling the space pass by. Then the flying ends, subtalar joint and plantar fascia absorbing the first impact of my landing. Gastrocnemius, soleus, and Achilles tendon maintain my stance, and along with my hamstring orchestrate takeoff. Then I am flying again, rectus femoris and iliopsoas swinging my leg forward.

My feet beat the drum of the earth, sarcomeres lengthening and then shortening, orchestrating flight and breath and blood flow. They lengthen and shorten, again and again. Intercostals and diaphragm labor rhythmically, cycling through hunger for air and fleeting relief.

As re-oxygenated blood returns to my left atrium, my attention returns to my thoughts. At first they fought for an audience, demanding my attention as I focus instead on the world around me, but soon it’s just me and my thoughts, as the air streams across my face. My legs stay strong, but beg me to stop. As I finish my run, my thoughts are with me, but whispering politely instead of shouting for attention, willing to leave as quietly as they came.

It isn’t the running, it’s the calm, the quiet, the peace in the cacophony. It isn’t the running, it’s the brisk morning breeze, the bronze fall leaves, the stars between the stars in the night sky. It isn’t the running, it’s me passing through space – a shooting star in the night sky trying to shine bright in the milliseconds I have to add a little light to the world. It isn’t the running, it’s the feeling of perfect harmony as the rhythm of my legs and arms and breath seems to match the rhythm of the world. It isn’t the running, so it is the running.

In the singularly focused chaos of medical school, running was just what I needed to reconnect with nature and the city around me. Earlier in medical school, a friend had asked me if I ran, and I answered, “Nope! Why would I run? I only chase soccer balls and cookies”. I am grateful that we are able to change, and I am now able to see beauty where I could see none before.

Photo Credit: Mark Hesseltine

Categories
disability Emotion Lifestyle Patient-Centered Care Psychology

Nodding Along

My grandmother was a strong and compassionate Egyptian woman, a mother of three, and a pathologist. On a glass slide, exactly like the ones she used daily, cells from her colon biopsy were identified as undifferentiated, and within days she was diagnosed with Stage IV Colon Cancer.

Although I am learning how to care for people in sickness and health, someday, the chest compressions will be applied to my chest. Disease knows no discrimination, and death unites us all. Thousands of cancer diagnoses and precise and growing knowledge of cancer cell types did nothing to protect my grandmother from that which she knew so much about.

In Egypt, cancer is called ’the bad disease’, and bad it is. Over the next couple months, we watched as the bad disease took our beloved grandmother away from us. During that time, my family members, and my grandmother, had to make a series of challenging decisions that they were very obviously not prepared to make.

Medical advancements, although the main reason we are living longer lives, have caused the complexity and variety of end-of-life decisions to be ever increasing. Uneasy about the series of decisions that my family had to make and handicapped by my ignorance, I found myself reading Being Mortal by Atul Gawande. Atul Gawande led me through a vulnerable and imperfect but inspiring conversation about death and dying, exposing our medical system’s inability to understand health beyond the one-dimensional, and presumptuously noble, endeavor to prolong life at any cost.

While reading Being Mortal, I found myself enthusiastically nodding along, agreeing with the theme of the book: we need to change everything about our simple but destructive approach to aging and our increasing elderly population. Our singular approach to prolonging life simplifies complex social and medical decisions. It seems the attitude now is that longer life is all that matters. Ensuring nutrition and shelter is our only standard for a viable living environment for the elderly. We are failing our parents and grandparents.

Atul Gawande’s presentation of ideas changed how I perceive aging and our healthcare decisions at the end of life. I became a strong advocate of having conversations about the inevitability of our death and the choices we want to be made during our end-of-life care. I was convinced that society and healthcare should ensure that the elderly remain the authors of their own stories for as long as they are willing, and actively empower them to do so. Nutrition, shelter, and minimizing fall risk are minimums of care, not acceptable standards.

The Literature in Medicine Student Interest Group at my school decided to read Atul Gawande’s Being Mortal, and I could not be more excited. In the middle of our meeting discussing the book, as I was passionately sharing my ideas, it occurred to me that although I was full of strong opinions, I had done absolutely nothing to be a part of the solution. My grandfather had come to live with us after his wife of 55 years, my grandmother, passed away from colon cancer, and my only roles/concerns in his care have been to ensure food, sleep, and meds. My strong opinions had not inspired my actions.

Nodding along to Atul Gawande’s criticisms of our medical system is easy, but having an honest conversation with my grandfather about his priorities and end-of-life care preferences as he reaches 90 years of age is not so easy. How might I empower my grandfather to continue to be the author of his story? Believing that healthcare is a right and not a privilege is easy, but carrying out the responsibility that this belief invokes is not so easy. How might I work to help provide all my neighbors with equal access to high-quality care? Practicing the invaluable intervention of presence is not easy, and working day after day to hone my abilities at the art of empathy is not easy. How might I overcome my doubts, fears, and insecurities, and avoid being frozen into lack of compassion?

Too often my strong opinions do not inform my actions. Too often my hate for dysfunctional and unjust systems overshadows my love for the people in the systems. I call myself to love my neighbors more than hate the systems, for love is actionable and hate is stifling and tiresome. Let love fuel the tank, for compassion-based activism is the only kind that goes the distance.

Photo Credit: Dan Strange