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Correspondence to J Hunt [email protected]
What you need to know
Psychological violence is integral to all forms of trafficking exploitation; physical and sexual violence are also prevalent
Trafficked people may live for years under the control of their traffickers, and the impact on their physical and mental health can be profound and enduring
Trafficked people are likely to have had pre-trafficking vulnerabilities (including poverty, destitution, experiences of war/community violence, domestic violence, adverse childhood events, disabilities, and learning difficulties) which can create cumulative harm
Stay curious in any consultation; ask appropriate, sensitive questions; create an environment where the patient can feel comfortable to talk openly; and apply “trauma informed” methods of working. Follow local safeguarding policies if you are concerned about a patient
A 24 year old woman from Nigeria presents to a male GP in the UK with vaginal discharge and inter-menstrual bleeding. She speaks limited English. Her notes show that she has received three diagnoses of sexually transmitted infections in the last year. She is accompanied by a man who looks older than she is, who offers to interpret for her. She responds without emotion to introductions and questions, and stares out of the window much of the time. An abusive or exploitative situation is suspected. The need for an intimate examination and further investigations is explained, and the accompanying man is politely asked to wait outside. The woman declines a chaperone. Further medical history is elicited through a telephone interpreter. The doctor asks gently whether she feels safe with the man and where she lives. The woman then becomes distressed and tearful and refuses to say anything further.
Trafficked adults experience, or have experienced, complex physical and/or emotional trauma, and are usually considered to be adults at risk. The UK’s Care and Support Statutory Guidance, first published in 2014,1 cites modern slavery as one of the 10 categories of adult abuse, and as a legally recognised form of child abuse in people under age 18, making it important for clinicians to have confidence in recognising possible victims and survivors, and in taking the first steps towards ensuring appropriate intervention.
When vulnerable adults and children are identified, clinicians are responsible for following local safeguarding pathways,1 and for urgently referring all victims,...