Forced to think that hell is a place called home
Nothing else to do but get her clothes and pack
She say she's about to run away and never come back.
- Ludacris, "Runaway Love"
Though I addressed all my questions to my 14-year-old patient, every answer came from the older man who brought her in to the clinic. "She just needs shots," he blurted, staring at his phone.
He said he was her Uncle Jimmy, and, no, he would not let me speak to her alone. He said he was in a rush, and wanted me to hurry up.
It's been a few years, but I still remember this girl, and how she stared at the floor.
I decided she was shy, vowed to follow up with her soon, gave her some shots, and sent the pair on their way.
Now I believe I may have failed her.
In retrospect, I have failed several of my patients. I have missed the subtle signs, the unspoken words, the unusual tattoo, clues to an ominous situation outside my exam room. My eyes were not open yet to their plight. I failed them.
Many of us have had contact with these potential victims. They come to our emergency departments with unexplained injuries, overdoses, and infections caused by unprotected sex. They come to our schools tired, truant, withdrawn. They come to our stores, buying clothes and jewelry inappropriate for their young age.
We have walked or driven by these victims in hot spots under the El on Kensington Avenue, by strip malls on Roosevelt Boulevard, and while waiting for flights at the airport. We have passed them at truck stops, military bases, and convention centers.
We have seen their faces on Facebook posts and weathered fliers stapled to utility poles.
In the past, they might have been considered just runaways. Today, they often are victims of sex trafficking, meaning they are being pressed into prostitution. It's important to note that any minor involved in sex trafficking is a victim; force, fraud, or coercion does not need to be proved, as it does for adult victims.
This is a form of modern-day slavery operating in shadows that must have light shined on them.
At least 100,000 children in the U.S. each year are at risk for sex trafficking, according to the U.S. Department of Justice. Philadelphia ranks in the top 15 of all cities. The most common age of entry into trafficking is 12 to 14, and 80 percent are girls. A single victim can make $1,000 a day for her pimp, her captor.
Human trafficking is both a crime and an emerging health-care priority. All health-care providers, particularly those in primary care, emergency care, reproductive health, mental health, and pediatrics, are well-positioned to identify and assist victims and those at risk.
Nearly half of trafficking survivors report having gone for medical care while under the control of their captors, yet most health-care providers have no training in recognizing victims.
Though traffickers often target schools and malls in their search for victims, the Internet has made luring victims even easier. Seduced with promises of love, attention, money, and fame, victims are separated from family, supplied with drugs, and threatened with violence if they disobey.
Children and teens who have been abused or don't have strong family ties are especially vulnerable. Many use "survival sex" to pay for food or shelter.
The American Academy of Pediatrics published a report last month that lays the groundwork for health-care providers to identify victims, to understand the health effects on children of trafficking and how professionals can work with community organization and the public to help victims and their families.
As a pediatrician, this report opened my eyes. It may have come too late for that 14-year-old with the overbearing "uncle," but I hope it will help other health-care professionals to do our part to stop this crime.
Victims live in constant fear - of harm to themselves or loved ones, of returning to an abusive home, of deportation, of shame and stigma, of being left alone. With so much on the line, victims - much like other trauma survivors - need our help to admit what is happening to them.
Health professionals are uniquely placed to reach victims, but any caring adult who sees a child who might be in trouble can take action. The National Human Trafficking Resource Center hotline (888-373-7888 or text BeFree at 233733) received more than 21,000 calls last year. The Polaris Project at polarisproject.org is a national advocacy group dedicated to disrupting the conditions that allow human trafficking to thrive.
Dawn's Place is the only residential program in the tristate region for women affected by sex trafficking; contact it at www.ahomefordawn.org. Covenant House, covenanthousepa.org, is a resource and shelter for runaway teens, and PATH (Physicians Against the Trafficking of Humans) at www.doc-path.org/ is a resource started by Jefferson physician Kanani Titchen to help health-care professionals identify and help victims of human trafficking.
In the fall, Philadelphia will host Pope Francis, a powerful advocate against human trafficking. "We must not allow these women, men, and children to be treated as objects, to be deceived, raped, often sold and resold for various purposes, and in the end either killed or left devastated in mind and body, only to be finally thrown away or abandoned," he has said.
We must open our eyes to this crisis and help victims out of the shadows and into a place of healing.