While many healthcare professionals have come across patients who are victims of human trafficking and modern slavery, most feel ill-equipped to help them to open up or to access the services they need, warns a UK clinician.
Modern slavery is a “significant health and public health threat,” said Dr Rosie Riley, a GP trainee based in Somerset and NHS England Clinical Entrepreneur. Dr Riley founded VITA Training, which teaches healthcare professionals how to identify modern slavery victims.
“We, as public health professionals, see victims of it, we see perpetrators of it, we see systems exacerbating it, and we see services ill-equipped to tackle it,” she said.
“But we have a powerful, science-led, evidenced-based voice that we can lend to policy, legislation, service provision, system creation, as well as those precious face-to-face interactions that we have with our patients,” she told the Royal College Physicians (RCP) Med+ 2021 conference on the 25th of October.
Dr Riley began her presentation by recounting the story of ‘Joe’, a 56-year-old man who presented to the emergency department.
He had been complaining loudly to staff and came “very close” to being ejected, but she eventually found him slumped on a chair, dishevelled and “smelling strongly of alcohol”.
He had no clear presenting symptom, as all of his complaints were longstanding, and Dr Riley was unclear as to why he had come. Asked what he did for work, “he slowly told me he had left his work” as a kitchen porter in a restaurant the week before.
When asked whether he was paid for his work, “he looked up at me… and told me he had worked all day, every day and hadn’t been paid in months.” It transpired he had been told he had debts to repay and they had taken his passport. He slept in a back room at the restaurant with five other men.
He was now homeless and had nowhere to go. His teeth were rotting, he had severe contact dermatitis, and bleeding fissures. He was also hypertensive, anaemic, and had tachycardia, with atrial fibrillation on ECG.
Dr Riley said that UK national estimates suggest that, in 2019, 10,627 potential victims of human trafficking, including 4550 children, were identified and referred, representing a 52% increase on the previous year.
Overall, the victims came from 169 countries, but the most common nationalities were British, Albanian, and Vietnamese.
However, these figures are likely to be an under-estimate, as the Global Slavery Index believes there could be as many as 136,000 people, or two in 1000 people, living in slavery in the UK.
“That’s the same prevalence as Parkinson’s disease,” said Dr Riley.
She continued that healthcare has a “huge role to play” in identifying victims, as they “are presenting in healthcare settings”. One estimate suggested that more than two thirds of survivors have been seen in healthcare “whilst being trafficked.”
A 2015 survey showed that one in eight healthcare professionals reported contact with a patient they “knew or suspected” of being trafficked, rising to one in five in maternity settings.
However, 80% of the professionals surveyed “felt they hadn’t had enough training,” with 90% saying they weren’t sure what questions they could ask to help identify trafficked patients, and 95% were unaware of the scale of human trafficking in the UK.
Dr Riley said that VITA Training, which works with NHS trusts, general practices, and trainee programmes, among others, hopes to bridge these gaps by explaining what constitutes human trafficking and modern slavery, and showing how to identify victims.
The training also explains how to offer trauma-informed care, and what to do during consultations, including how to remove other, potentially unhelpful people from the consulting room without raising suspicion, and how to refer patients to the appropriate agencies.
This is within the context of an A–E list of dos and don’ts:
Give control to the patient
Don’t continue if there are signs of distress
Explain, including the ‘what’, ‘how’, ‘why’, and ‘how often’ of any treatment offered
Dr Riley emphasised that a “positive outcome” in this context “doesn’t mean ‘grateful victim rescued by brave doctor.’”
It is rather about “planting a seed in every consultation that suggests: you are a valued individual worthy of dignity and care, and when you’re ready this is a safe place and we’re safe people.”
In the subsequent discussion, session chair Professor Chuka Nwokolo, honorary professor of gastroenterology at Warwick Medical School, Coventry, asked how easy Dr Riley has found it to access translation services, as “a lot of these patients don’t speak English”.
“It can be enormously challenging,” Dr Riley said. “If I anticipate I’m going to have a translator, I make sure I have extra time.” She tries to have a separate room available so she can separate the person from anyone they have with them.
“One thing I would say, if you are using translators, is brief and debrief,” she said, such as asking translators beforehand to translate “word for word”, and then checking if the translator is okay if they have heard a traumatising story.
No funding declared.
Dr Riley is Founder and CEO of VITA Training.
Med+ 2021: Abstract Modern slavery is a major health and public health threat: how do we respond? Presented 25 October.
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Cite this: Liam Davenport. HCPs in a Unique Position to Help Tackle Modern Slavery - Medscape - Oct 26, 2021.