Invisible Patients: Human Trafficking Victims

Jun 07, 2021

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I often hear: ‘We don’t see human trafficking victims.’ I say: ‘You’re right. They are there in your hospital, but you’re not seeing them.

Candace Rich

You have probably treated a victim of human trafficking ‒ without even knowing it. Up to 88%* report interacting with a healthcare provider during their trafficking experience, due to the sex work, manual labor and physical abuse they are forced to endure.

That statistic is often cited by Reclaim611, a nonprofit founded by two nurses: Carrie Schirato, MSN, RN, FNP-C, ANCP-C, and Candace Rich, MSN, RN, CPNP. Reclaim611 provides training and resources to help healthcare professionals recognize and report human trafficking. Carrie and Candace both work in emergency departments (EDs) in Texas — Carrie at Baylor University Medical Center in Dallas and Candace at Cook Children’s Medical Center in Fort Worth.

These two dedicated leaders answered our questions about the red flags of human trafficking, Reclaim611’s many services that you can use and their experiences helping victims of modern-day slavery.

How did you come to realize the power of healthcare professionals to address human trafficking?

Candace: When we realized how common it is for trafficking victims to have contact with a healthcare professional during their trafficking experience, we wanted to help our profession “see the unseen.” We believe if healthcare professionals are equipped with the appropriate tools and resources, we can have a significant impact on the fight against human trafficking.

What are some red flags of human trafficking that medical professionals can look for?

Carrie: Red flags of human trafficking that medical professionals can look for include the following:

  • Gives scripted or inconsistent stories that do not match the patient’s presentation and/or exam findings
  • Has history of physical or sexual abuse
  • Has history of UTIs, STIs, multiple pregnancies, abortions, drug abuse, mental illness and/or suicidal ideations
  • Is unable to provide an address, “new in town”
  • Cannot provide emergency contact/has no social network
  • Anxiously refuses to be without their phone
  • Is not in possession of ID
  • Accompanied person does not let patient speak for themself or insists on translating for patient
  • Demonstrates evidence of controlling or dominating relationship
  • Avoids eye contact, fearful, nervous, shows hostile behavior, doesn’t trust healthcare personnel
  • Describes having a job that is different from the work they may have been recruited for
  • Mentions living in crowded conditions and working long hours
  • Says not allowed to take breaks at work to eat or drink
  • Mentions having significant debt

It is important to note that there is not one red flag in particular that will confirm human trafficking, but rather it is usually a clinical picture that involves a vulnerable individual with evidence of all or some of the various red flags mentioned above.

Although up to 88% of human trafficking victims have come into contact with a medical professional during their trafficking experience, less than 1% of healthcare professionals report it. Why do you think that is?

Carrie: Generally speaking, what causes lack of recognition is lack of awareness and education. Healthcare professionals cannot be expected to recognize something they do not have the eyes to see or understand. Human trafficking is considered the second-largest criminal industry in the world, yet there is an absence of standardized education and protocols in medical facilities. In order for healthcare professionals to be empowered to act, they have to be appropriately equipped with the knowledge, resources and support from their facilities.

What was it like preparing a presentation on this topic for virtual NTI 2021? Tell us about that experience.

Candace: It was great! NTI is hosting an amazing conference with the online experience, and we are incredibly honored to be a part of it. We have a standard three-hour training that we compacted down to one hour to best fit the presentation time and learner experience.

Your organization provides an array of resources for healthcare professionals. Can you give us an overview of Reclaim611’s services?

Candace: All of our resources are free, and we are honored to offer our peers:

  • Three-hour comprehensive training with CMEs for MDs, NPs, PAs, RNs, social workers, pharmacists, psychologists and CHECs
  • Comprehensive, fully integrated protocol with the ability to fit any clinical setting and customized as needed
  • Downloadable references for clinicians
  • Resource posters for victims
  • A 24-hour hotline that healthcare professionals can call

How does your organization help medical staff set up protocols to recognize and report human trafficking?

Candace: We provide a comprehensive, fully integrated protocol with the ability to fit any clinical setting and customize as needed. If you would like to customize the protocol for your clinical setting, please contact us.

Can you tell us about a time when you intervened and helped a victim of trafficking?

Carrie: One of my colleagues consulted with me one day due to a concern she had as the ED triage provider. The situation involved two 21-year-old females and one male who all presented to the ED with STI concerns.

They were placed in separate rooms for evaluation within the same treatment pod. My colleague noticed that the male patient was frequently walking down the hall and checking on the two female patients in their rooms. As I happened to be on shift that day, I was able to interview one of the girls, and she described being a victim of interstate trafficking. Using Reclaim611’s protocol and trauma-informed care, I was able to help facilitate keeping this patient safe while I coordinated law enforcement intervention. The pimp was detained by law enforcement in the emergency department and later this was confirmed as an interstate trafficking case.

The victim and her pimp had been in the Dallas area for 48 hours and she had no idea what city she was in, where she was staying or how long she would be there. She hesitated to answer direct questions and required gentle and frequent prompting while obtaining her history of present illness. She had a quiet and nervous demeanor with poor eye contact and a medical history of multiple STDs, multiple failed pregnancies and mental illness. She had been lured to another state by a female recruiter, the other female patient in the ED, and was expecting to begin a career in modeling prior to meeting her trafficker. The ED visit that day was necessary because the “John” refused to use protection with the girls the night before, and they needed STI prophylaxis.

If someone reading this blog is interested in helping train personnel at their organization, or just learning more about human trafficking, how can they get started?

Carrie: You can check out our website at Reclaim611 or email us at for any training questions. We have also launched a podcast called “The Remnant by Reclaim611,” where we discuss all things related to human trafficking, including survivor stories. This is a great way to learn more about human trafficking, obtain resources and encourage one another to step into the fight against modern-day slavery.

With the needs of your nonprofit, hospital work, family and personal life, how do you juggle all of this? You do have to sleep!

Carrie: Yes, there are a lot of things to juggle on a daily basis. As a grassroots effort, we have had an exceptionally steep learning curve trying to understand the nonprofit sector, serve our families, stay dedicated to our profession and remain faithful to the call to stand up for the enslaved. We never anticipated a smooth road or a lot of sleep, but every challenge has been matched by incredible opportunities to impact lives. The most important concepts I have adapted into managing a full life are flexibility, perspective and lots of prayer. Successful juggling is often a matter of establishing a foundation of priorities, routines and boundaries ‒ and being willing to say “yes” to the unknown despite the possibility of failure. So much of the time it’s the one small “yes” after another that leads to the greatest impact. The services we have today are the product of many small steps, not to mention supportive family and friends who are dedicated to the mission of ending human trafficking.

*Lederer, I.J., & Wetzel, C.A. (2014, Winter). The Health Consequences of Sex Trafficking, Annals of Health Law (23)(1).