Dentistry's Responsibility in Human TraffickingOct 29, 2020
The American Dental Association has a Principles of Ethics and Code of Professional Conduct whereby the dentist is “obliged to become familiar with the signs of abuse and neglect and to report suspected cases to the proper authorities consistent with state laws.” Human trafficking falls into this responsibility of not just the dentist but should include the entire staff. Dental assistants and hygienists are in an excellent position to notice suspected abuse or neglect.
The United States Department of State estimates that more than 26 million people are subjected to human trafficking worldwide and the United States is a key source, site of transport and destination for trafficked individuals. Estimates show that 28% of victims have come in contact with a health-care provider and specifically a U.S. based survey of survivors found that 26.5% were seen by a dentist along with other health-care providers.
Victims of human trafficking have a variety of issues if they do seek out dental treatment. Injuries of the head and neck including teeth and jaw fractures, mandibular dislocations, as well as oral lesions associated with STD’s. Neglected health conditions – such as uncontrolled asthma, hypertension, diabetes, untreated skin infections, untreated caries and periodontal disease are signs that the patient may be a trafficked victim.
Some of the signs to look for:
- Victims are not in control of their own ID’s or insurance cards.
- Fearful, anxious, depressed or nervous (often looking around before talking).
- Startled easily.
- Emotionless and/or withdrawn.
- Unmet dental needs.
- Appears malnourished and dehydrated.
- A tattoo or brand in a highly visible area.
- No personal belongings.
- Claims to be just visiting, and unable to convey where they are living.
- Accompanied by a third party who offers to pay in cash.
- Third party is demanding and controlling.
- Third party is interested in cosmetic procedures and not a long-term treatment plan or preventive care.
- A discrepancy in age of the victim to trafficker (the third party that is with them).
If at all possible try to separate the patient from the third party that is accompanying them. Taking a radiograph in a different room can be a great way to separate or asking the third party to do some extra paperwork in the front office. Remember to never confront the suspected trafficker. Some assessment questions that will help the clinician identify the victim and show an interest in helping without judgement are as follows:
- Are you living or working in a safe place? Where and when do you sleep?
- Have you ever been pressured to do something that you didn't want to do or were uncomfortable doing?
- Have you ever been threatened or intimidated by someone? If so, what did this person say would happen to you?
- Are you able to come and go freely at home and work?
- What happens if you leave or talk of leaving home or work?
- do you have access to any money or the money you earn? Has anyone taken some or all of your money, or held your money with promises to keep it safe?
- Does someone control, supervise and/or monitor you and your work?
- Has your communication with others been restricted or cutoff? Have you ever had a phone or computer? What happened to those items?
- Do you have days off from work and what do you do on your days off?
- Has someone ever taken your identification papers ,passport or other personal documents?
Rarely victims self-identify making it difficult for professionals to intervene. Trafficked victims may underreport because they lack access to legal or support services. They fear retaliation from their traffickers against themselves or their families. They have been conditioned to fear and distrust anyone other than their captors including law enforcement or other authorities. They also fear the consequences of being identified as illegal immigrants or criminals instead of victims. Victims feel ashamed that they won’t be accepted back into their families and have an enormous sense of hopelessness.
There are many states that now require dental professionals to take courses in human trafficking which is a step in the right direction. We must also have protocols in place that the entire team ought to be aware of if there is a suspected case in the office. We have mandatory reporting and the practice should contact local law enforcement for guidance regarding how to report.
Human Trafficking hotline 888-373-7888
Some Information adapted from The Polaris Project, a non-profit, non-governmental anti-trafficking organization.