According to Article 3 of the Protocol to Prevent, Suppress and Punish Trafficking in Persons ,‘Human trafficking is the recruitment, transportation, transfer and harbouring of persons either by use of force or threatening them or any other methods that are aimed at coercing, abduction, deception, fraud, use of abuse of power or of a position of vulnerability or of giving or receiving of payments or benefits to achieve the consent of a person having control over another person, for the purpose of exploitation. ‘According to the article, exploitation includes prostitution or any other forms of sexual activities that include coercion to participate in sexual acts, forced labor, slavery, removal of human organs and servitude. Human trafficking has three main elements according to the law (Chisom-Straker et al., 2016) . The act of traffic which involves what was done, the means which involves how it was done and the purpose which explains why it was done.
In the United States, human trafficking has been reported to be on the rise even though data to support the finding is hard to find. It has, for this reason, become a public health issue of concern since it affects individuals, communities in general including families. Sex trafficking and labor trafficking are considered severe forms of trafficking according to the trafficking victims protection act of the year 2000. Recent studies indicate that close to fifty percent of individuals who are trafficked see a healthcare professional in the period of the exploitation (Chisom-Straker et al., 2016) . The exploited individuals usually have issues with their health and need a wide array of healthcare services which include psychological pathologies, sexually transmitted infections, HIV/AIDS, malnutrition, skin conditions physical injuries and in some cases Tuberculosis.
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As more information is obtained on the implications of human trafficking the healthcare providers have realized that survivors and victims are in the majority of cases likely to interact with healthcare professionals during their period of captivity. It is a public health issue, and therefore the healthcare facilities are very crucial in the response and prevention of human trafficking. The disruption of trafficking by the healthcare sector is known as the anti-trafficking movement within healthcare. Various organizations have come up to provide education and training for the healthcare providers on the trauma-informed network. It helps in the recognition of trauma and its symptoms and the role it plays in the lives of their patients.
There is a role for lawyers in ensuring that healthcare facilities have appropriate protocols in place to address the trafficking scourge. The protocols ensure that the patient, providers and clinical staff safety is taken to account and the procedures to be undertaken when a victim of trafficking presents themselves for treatment with the perpetrator of trafficking. There also ought to be mandatory reporting in hospital protocols. Not all states have the protocols to report trafficking. However, most states have protocols of reporting child trafficking such as Maryland. It states that the child protective services or the local enforcers of the law are called. It is essential that the hospital protocols are aligned with state laws. States that are more attuned to human trafficking have mandatory protocols of provider education on human trafficking. In Florida, for example, it is mandatory for nursing to have education on human trafficking to create awareness of the increase or presence of human trafficking in our society.
There is ICD-10 on human trafficking that is set to be adapted by hospitals. It is in the habits of the perpetrators to utilize their control on their victims on all aspects of their lives. Therefore, this may cause the perpetrator to have access to information on the health status of their victims from the healthcare providers and may have the authorization to their medical records. It is therefore vital that all healthcare providers ensure that the patients maintain control over their health as opposed to the trafficker. This can be achieved by ensuring a good relationship with the patient that enhances the safety and interest of the patient as a priority.
The standard operating procedures are guides to guide all the stakeholders and relevant persons to combat human trafficking in most hospitals and healthcare facilities including my pace of practice. They include identifying and screening the protocols, offering direct assistance, conducting investigations, prosecution and finally referral and case monitoring framework — identification and screening aim at ensuring that there is sufficient determination of the status of the victims (Gibbons & Stoklosa, 2016) . The healthcare providers then involve the national stakeholders that include the social service department and other relevant non-governmental organizations. Here, direct assistance helps patients receive the appropriate treatment holistically. The social workers assess the family and community conditions before return to their homes.
After the healthcare provider has identified and involved the relevant stakeholders who include the police, the commencement of investigations is done where a statement is offered and immediate assistance offered to begin investigations (Gibbons & Stoklosa, 2016) . The law enforcement officials are provided with the necessary tools to conduct a victim-centered inquiry. After investigations, the perpetrators are expected to be prosecuted and the healthcare providers ought to have the social responsibility of being a witness in the prosecution of the perpetrators (Gibbons & Stoklosa, 2016) . Finally, there are referral guidelines that are prescribed in the standard protocols of the hospital. They outline very comprehensive referral mechanisms that are patient-specific and ensure appropriate assistance to the patient.
Identification and screening are key and healthcare facilities ought to give education on the same. Identification involves noting reasonable evidence that may lead to the conclusion that an individual is trafficked. There ought to be education on the identification of victims by health care providers and the proper process or chain of command that helps in the general help of the victim. The person who identifies the victim should fil the case to the police immediately and the social service department or the victim informed of their requirement to report the matter (Fedina, Williamson, & Perdue, 2016) . They should be trained on the initial signs of trafficking to help them identify victims. They include young age, the last location where the suspected victim was before the presentation, the circumstances before the presentation and signs of physical abuse. They ought also to have information on how to have a child-friendly approach to interviews. There is also the need to have information on how to handle the aspect of mental health in victims. It is known that most victims of trafficking are women constituting about 80 percent of all victims of human trafficking. Due to this fact, there ought to be training and a resolute determination of the information that concerns the female victims of trafficking.
Victims of human trafficking present with signs of malnutrition and symptoms of physical abuse and injuries. They also appear to avoid eye contact, avoid any form of social interaction and are in fear or anxiety in the presence of authority figures and law enforcement (Fedina, Williamson, & Perdue, 2016) . They occasionally lack any identification documents, have poor dental and physical health and may have brandings in their bodies or tattoos. Their history of residence and occupation mostly indicates that they live in their place of work. They may have severe untreated sexually transmitted infections. They also may not speak for themselves in the presence of their perpetrators.
References
Chisolm-Straker, M., Baldwin, S., Gaïgbé-Togbé, B., Ndukwe, N., Johnson, P. N., & Richardson, L. D. (2016). Health care and human trafficking: we are seeing the unseen. Journal of Health Care for the Poor and Underserved , 27 (3), 1220-1233.
Fedina, L., Williamson, C., & Perdue, T. (2016). Risk factors for domestic child sex trafficking in the United States. Journal of Interpersonal Violence , 0886260516662306.
Gibbons, P., & Stoklosa, H. (2016). Identification and treatment of human trafficking victims in the emergency department: a case report. The Journal of Emergency Medicine , 50 (5), 715-719.
