When Marie was being sold for sex throughout California, she was rarely away from her pimp. Even when he wasn’t physically confining her, she was frightened he was watching or listening.
Marie, a 27-year-old who asked to be identified by her middle name for safety reasons, was first exploited by an older man when she was 16. She was traded between pimps and forced into sex work for nearly a decade.
She said visits to the women’s health clinic were her only chances at escape, but providers never tagged her as a trafficking victim. They just gave her antibiotics to treat the bladder infections she contracted from frequent sex work and sent her on her way.
“You have to go to the doctor — that is one safe place,” she said. “They don’t have badges.”
Victims may be more comfortable talking to a nurse or doctor than a police officer. Though trafficking has historically been seen as a law enforcement issue, clinics and hospitals are starting to play a role in identifying and helping victims.
Advocates say it’s on medical professionals to take action. A 2014 survey of sex trafficking victims found that 88 percent had contact with a health care provider at some point while being trafficked.
But Marie said even at the clinic, she was too scared to say anything about her situation. Her pimp had total control over her. He would starve her if she wasn’t making enough on the streets, clobber her if she didn’t look the way he wanted her to. She recalled being too afraid to run, and unsure about how she would survive on her own even if she did.
“It’s manipulation,” she said. “Control the body, control the mind. So you physically control the body by hitting, beating. … My son’s dad broke me in a way I have never been broken, and I guess he was really pimpin, cause I knew I was being controlled, but I couldn’t really do anything about it.”
Some girls might not be ready to get out yet, because they're too scared. We're already being forced to do enough. It's touchy.
– Marie, sex trafficking survivor
Dr. Ron Chambers, a family physician with Dignity Health, is trying to prepare the next generation of doctors for situations like Marie’s. His South Sacramento clinic is one of few in the state where staff are specifically trained to identify and treat sex trafficking victims. It’s also one of the only residency training programs with a trafficking curriculum.
“You can’t open up many medical textbooks that have any information about human trafficking in them,” he said. “How do we know what labs to order? How do we know what medications are appropriate? It’s heavy duty PTSD that we’re dealing with.”
Chambers launched his sex trafficking safe haven program in summer 2016, and he’s seen about 150 patients so far. Now, he’s working on bringing the model to Dignity Health residency programs all over California, and sending identification protocols to health systems across the country.
He said there are telltale signs that should alert medical staff to a sex trafficking situation. If a woman is accompanied by a man who insists on staying in the room or who seems to be answering for her, that’s a red flag. Bruises, branded tattoos, or hotel keys should also set off alarms.
“Literally not knowing what city they’re in, what state they’re in, because many of the victims we’ve seen have been trafficked between states and cities, often at night,” Chambers said. “They lose time, they lose location, their whole life for months or years has been being held captive as a sex slave.”
At Chambers’ clinic, staff are trained to ask sensitive questions without prodding, and they’re told to avoid judgmental or shaming language. When victims who’ve been referred by local sex trafficking resource organizations come in, they can enter discreetly through a side entrance to minimize waiting room anxiety. They get longer-than-usual appointments and access to a crisis hotline after they leave.
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But when the women’s shelter Marie sought sanctuary with after she escaped wanted her to see Chambers, she was afraid. Little by little she became comfortable enough to share her story with him, which helped him more accurately prescribe a medication regimen.
She said nurses and doctors have to be alert and ready to help, but they can’t come on too strong, especially when dealing with patients who are still being trafficked.
“Some girls might not be ready to get out yet, because they’re too scared,” she said. “We’re already being forced to do enough. It’s touchy.”
Kate Walker Brown, the director of child trafficking for the National Center for Youth Law in Oakland, said the 72-hour window after someone escapes is a crucial time for mental and physical health care, but too often the victim gets tied up in the juvenile probation system.
She said cops and doctors should be working in tandem to make sure exploited youth are getting the right course of treatment.
“What we’ve seen across the state is, as medical providers are getting more information about trafficking victims and trafficking generally and what to look for and how to have conversations, we’re identifying more victims,” Brown said. “So, training must happen.”
Chambers’ work supplements other efforts between national trafficking organizations and health systems. Sutter Health trains their emergency department staff on trafficking protocols yearly, and UC Davis has produced research on how to identify potential victims.
“If we can establish these medical safe havens, I think we really have the opportunity to change the game and keep them out of the life and get people going on a road to recovery,” Chambers said.
If you’re being trafficked or know someone who is, call the National Human Trafficking Resource Center at 1-888-373-7888.