Relentless in Action: meeting the needs of the people
One of the great things about health care is that it is always a way to meet a need, and that even lay people can recognize the need and get involved. There are so many ways in which health intersects the care of trafficked people.
Health needs loom large in the concern for trafficked people, either urgently or in long-term follow-up. However, care must be given with genuine sensitivity so as not to re-traumatize the patients. There is an urgent need for research to know just what the issues are and how best to treat them – this population has not been represented well in health research.
Caring for trafficked persons is a long term effort of holistic health care. People who have been trafficked have suffered chronic mental and physical trauma, and caring for them is not easy. It can be difficult to find practitioners in any country willing or able to continue in their care. There are several reasons for this: the survivor may be moved for legal reasons, the responsible agency may change, and reimbursement for services may be low.
Daryna has been living in a shelter for trafficked women in Moldova for 10 months. Her physical wounds are healing but she continues to suffer from headaches, symptoms of anxiety and Post Traumatic Stress Disorder. She is getting some help from lay counselors who have been getting special, yet intermittent, training in dealing with chronically traumatized people. However, it can be difficult to find health professionals who will continue to care for her in a holistic way: incorporating mind, body, and soul.
Health care is one area where trafficked people may intersect with the public sphere. Professionals need to be trained to recognize, identify, and patiently work with a victim; as well as be an advocate for this person. Training needs to be done in all these facets of care so that identification, care, and referral to the proper people can be safely done.
Jessica, a fourteen year old American teen, visits an emergency department for abnormal uterine bleeding, and she is there with her boyfriend/pimp. It is late at night and they give some strange story, including a lie that she is nineteen, that doesn’t quite add up, and the girl looks not well, but not bad enough to admit to the hospital. Besides, there is no financial coverage for the stay. Furthermore, the doctor is tired and doesn’t feel like dealing with the attitude. He gives some medicine to help with the bleeding and to cover some treatment for sexually transmitted infections and tells them to follow up. Of course she doesn’t.
Training and equipping of an organization’s staff members, whether they are national or foreign, highly educated or not, is an important component of work to address the health needs of trafficked people right where they are. So much can be done to improve health of people with knowledge and information and empowering them to take care of things, and do it well.
Ming Yun is a 24 year old Chinese woman who serves on staff of a program that runs an outreach and shelter program for trafficked women. Ming Yun herself was trafficked as a young teen and came through the shelter program where she now works. Because of her own experience, she passionately wants to help others through their physical and emotional pain. However, she feels so ill-equipped to do so and seeks out help wherever she can.
Health care professionals, when they are thorough, yet very gentle, talking with patients, are able to elicit important information that may not be routinely offered by a patient, particularly when it is not culturally intuitive to do so.
Guneet, a 22 year old woman in Delhi, was brought up as a devadasi (temple prostitute) then continued being pimped as a prostitute because according to her society she is not good for anything else. An organization trying to work with this group of women had been doing some HIV/AIDS education as well as promoting condoms and testing. An independent group came alongside and started to talk with the women in Guneet’s neighborhood about things like their children, their health, and their feelings. Out of these conversations a colleague documented that these women deeply cared for their children (more than themselves) and that they suffered from acute mental illness and they were suffering terribly – this information was news to the well-intentioned but misguided NGO workers who thought that HIV was the most important issue to these women, but hadn’t stopped to ask. They subsequently started to implement mental health interventions along with HIV protection.
Providing direct health care is one way to reach to people who are vulnerable to being trafficked, those already out of exploitation, as well as, in some instances, to those already in trafficked or precarious situations. Outreaches that bring in vulnerable people can expose them to services available to them, and give them an opportunity to interact with people who want to see them live free lives.
Frieda brought her daughter and two sons to see visiting American doctors at a free clinic held at a residential compound just outside the city. She was invited by some people who regularly visit the mothers and their children in the brothels of Managua, inviting them to join sewing and jewelry-making classes as well as Bible meetings at this shelter. Frieda had heard about this place, but had never ventured out there due to work restrictions, time, and money. Since just about everyone else she knew was going there, and transportation was being provided to the clinic, she decided to take advantage of it. She met many kind people who lived there and she started to think about another kind of life – one that is safer for her children, more life-giving to her.
Prevention with simple community health development can help lift a village (rural or urban) out of dire straits where people are at least a bit less vulnerable to being trafficked. It can also help protect children from being caught up in exploitation as well – or at least stop them from being exploited further.
Nhean’s mother started to wonder when she noticed her neighbor’s house looking cleaner, less trash around, and how she tended more carefully to the water supply. Neighbors were discussing the health talks and the idea of a health monitor for their village. She decided to attend one of these, and as the neighbors all started working together a decrease in flies, stench, and most importantly, in sickness was appreciated. Less sickness means less trips to the clinic and therefore fewer medicine bills. Fewer bills… well, you could say that Nhean, a six year old Cambodian boy, may have a reduced vulnerability to ending up in slave labor or commercial sexual exploitation.
One must not overlook the health care of millions of slave laborers around the world. Many more are being identified and rescued, but the development of adequate care in the investigation and deportation stage is sorely lacking. Addressing the whole spectrum of problems of trafficked people, not just the legal/immigration ones, is an important gap in care that needs to be closed.
Kamol, a Thai man, was sound asleep in the hull of the fishing vessel when the door burst open to bright daylight and the sound of foreign voices. He had been rescued from his enslavement, but the hurt and confusion did not stop right away. The process of deportation and investigation was a bit rough, due to the circumstances. But through the ordeal of getting back to his home in Thailand, nobody bothered to do a thorough medical exam on him to even treat the sores on his skin or give him vitamins to help his malnutrition. All that was done was a blood test, presumably to check for HIV.
Prevention through addressing an unjust health care system is another way to break the cycle of humans oppressing each other. Inadequate health care, Unaffordable basic health care, and health care that is substandard and sometimes dangerous are problems that contribute to a person’s risk for becoming enslaved to another.
Xiao Wang prostitutes herself because it is the only way she can make enough money to pay for her child’s health care. Her son is profoundly affected by cerebral palsy. She decided to keep him, rather than abandoning him, despite the urging of her family. She has been willing to pay dire consequences to care for her child. There is no effective or adequate welfare system for special need children in China. Furthermore, the treatments recommended by the Chinese doctor were very expensive, but are not considered standard according to the recognized medical literature. The injustices of poor health care for children with disabilities, the discrimination and societal pressure to abandon a child with a disability, and the expensive non-standard treatment compound upon one another.