b'AWARENESS GUIDE|not be with the patient] and who is trainedbe refusing to leave the room so that diffi- bal communication or any type of evidence in spotting the signs of trafficking so that thecult questions can be asked privately, sheis going to be key. You could also ask for a patient can be pulled away to safety, Estes.continued.copy of someones license to try knowing Those signs are typically similar to domesticYou want to ask them if they are in awhere they live in case they leave the hospi-violence situations and include: dangerous situation, if they want out of theirtal before you can get them help.The companion not only wont leavesituation, if you can help them in any way, their side, but answers questions forshe said. You want that person to feel safeADDRESSING THE FLIGHT RISKthem about their injuries and/or explainsbecause they dont ever feel safe, becauseIn some instances, the known or suspected how the injuries occurred. theyre not safe. So you need to use safevictim is going to leave the hospital before Signs of old injuries that have not healedwords such as, Youre in a safe space, Ima safe alternative for them can be estab-properly, such as a broken arm that hashere to help you, dont be scared. lished, whether it be that they leave alone healed on its own or poor excuses forEstes also suggests not telling the patientor with someone else. Should this happen, repetitive injuries, such as I keep fallingthat you plan to call the police or any otherEstes says that calling 911 is always the best down the steps. authority. Theyre commonly terrified ofmove to initiate an investigation as well as Difficulty in speaking the English lan- the police and told not to trust them byto satisfy the duty to warn and avoid theTheyve been programed to think that people like the police, doctors, and nurses will deport them from the United States. Theyve been told that hospitals are dangerous places.guage, as many victims are being traf- their handler, Estes said. Theyve been pro- potential for litigation in the event than ficked from the Ukraine, Russia, Mexico,gramed to think that people like the police,an unreported incident results in a case of and Venezuela, where English tends todoctors, and nurses will deport them fromnegligence when criminal activity occurs. be their second language. the United States. Theyve been told thatWhen the suspected human traffick-Appearing malnourished. hospitals are dangerous places. ing is reported and the appropriate Avoiding eye contact. That said, once its determined that helpauthorities investigate, theyll gather any Lacking official identification and per- is necessary the healthcare provider shouldinformation available to look for the indi-sonal possessions. consult the National Human Traffickingviduals involved, Estes said. Everyone Claiming to work excessively long hoursHotline (888-373-7888) and get into contactis going to benefit from an investigation. and/or living at a place of employment. with a social worker who can be brought inValerie Simonsen, ND, a naturopathic phy-Poor dental health.to assess the situation and determine nextsician and human rights activist, urges Tattoos/branding on the neck and/orsteps. With time being of the essence, Estesproviders to establish direct links with lower back. also suggests ordering x-rays and blood- authorities in their communities, such Untreated sexually transmitted diseases. work for the patient to help prolong theiras an attorney general, to help to expe-visit, even if it comes at the expense of thedite any follow up needed related to any KNOWING WHAT TO SAY & DO, patients companion being made aware.concerns that they have for patients. WHAT NOT TO SAY & DO You could always say that you want to doChristina M. Madison, PharmD, FCCP, Upon suspecting or outright identifying a vic- a full workup to make sure that theres notAAHIVP, founder and chief executive offi-tim, the first step is to get them into a roomanything underlying happening, Estes said.cer of The Public Health Pharmacist, a public with a healthcare professional where there isIf youre doing any blood draws, youll havehealth consulting firm, believes that provid-no threat of interference, Estes advises. YouDNA samples if needed. And theres alwaysers who could come into contact with vic-need to have a staff member who is strongsomething to be considered for evidence.tims consider sensitivity training, including enough to remove someone who mightAnything that you can say or do to get ver- trauma informed care, to balance the impact 18 AWARENESS GUIDE|2020| www.elitecme.com'