Human trafficking doesn’t just happen in New York, Miami and L.A. It’s happening in rural communities and urban centers throughout the Southeast. And the most horrifying aspect of it is that many victims are trafficked by a family member.

Health care workers, whether they know it or not, encounter trafficking victims regularly. “People who are trafficked usually, at some point, come through the health care system,” said Tameka O’Neal, Novant Health vice president and chief provider experience officer. “And most of the time, it’s at an urgent care or in the emergency department.”

Statistics show that 90% of victims have a touch point in a health care organization, O’Neal said.

O’Neal was tapped to lead the implementation of an online training course to build awareness of human trafficking and teach team members what to do when faced with it. It started when O’Neal’s leader – Dr. Eric Eskioglu, a neurosurgeon and Novant Health’s chief medical and scientific officer – was contacted last year by Safe House Project. “Dr. Eskioglu thought I would be best suited to lead this collaboration,” O’Neal said. “He’s aware of my history. I've been a victim of violence and sexual abuse. I have a lot of personal engagement in this territory.”

Safe House Project is a Washington, D.C. area-based nonprofit combating domestic sex trafficking by increasing identification of trafficked individuals through training and support.

O’Neal recognized that this crisis went beyond the original conversations, which she said centered on physicians and advanced practice providers receiving training on what to watch for.

“In health care, there are others who need to know,” she said. “Custodial staff, administrative staff – we can all play a part in helping victims. So, we decided to roll this training out to all Novant Health team members.” She’ll be separating the curriculum into two pathways – one for clinical and one for nonclinical staff.

O’Neal paints a vivid and terrifying picture of what trafficking victims endure. The family might need money for food, clothes, drugs or alcohol, she said. “They essentially pimp their children out in order to get what they want. As a child, you don't understand what's happening. You think you're doing it for the family. You think you're saving your family from being evicted.”

If the family member isn’t themselves the abuser, they are usually the “connector” to an abuser, O’Neal said.

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Novant Health adopted this training as an extension of its Diversity, Equity and Inclusion initiatives. The training will help Novant Health teammates in every department know the signs to look for. “All along the way – starting at the emergency room reception desk – there are opportunities to identify trafficking victims,” O’Neal said.

This curriculum, written in collaboration with the Academy of Forensic Nursing, is a survivor-informed, trauma-informed and patient-centered training.

“There are signs someone is being victimized,” O’Neal said. “With domestic violence, it’s usually the partner or spouse who will take their victim to the emergency room after they've injured them. Body language speaks more volumes than words. If the handler is trying to make sure their victim is close to them at all times, that’s a sign. If the victim goes to the bathroom, and the handler tries to follow, that can be a sign.”

“The Safe House Project training gives us the signs to look for,” O’Neal said. “There's nonverbal communication we need to be aware of. Then, we need to figure out the safest way to go about separating the victim from the handler. For example, especially if the child is underage, you can say: ‘We need to take them for an MRI, and you're not allowed in the room.’ The first step is to safely separate the victim from the handler.”

The eight education modules are, for now, voluntary. But O’Neal is working on making the training mandatory for all team members. Before the Safe House Project training went live, “People went off their intuition,” O’Neal said. “As health care workers, we sometimes have that ‘Spidey sense’ that something isn't right.”

Calling in law enforcement

If a team member suspects they're seeing a trafficker and victim, what happens next?

Stabilizing the patient is step one, O’Neal said. “And we have to address their mental and emotional health in tandem with appropriate medical care. We call in our behavioral health professionals. If what we suspect is confirmed, we would seek county and state officials who can help. We would also reach out to local law enforcement.”

The victim has likely been conditioned not to report abuse. Victims are often threatened not to say anything and not to give any signs in public, O’Neal said.

Sex trafficking happens to children – including boys – and young adults of all ages. Typically, you see it with adolescents between 10 and 14. “Children that age are easy to manage,” O’Neal said. “Children believe they're saving the family from losing their home. They look at it as a martyr situation.”

Trafficking disproportionately impacts Black and Brown communities. Black women make up 40% of sex-trafficking victims, studies show.

O’Neal knows what it means to survive a life-threatening situation. “As a victim of violence, I recall the fear,” she said. She also understands that women sometimes stay in abusive relationships because they feel the kids need their father. The women often also need financial support and feel trapped, she noted.

Offering hope

Novant Health earned Safe House’s 2022 Hope Award for being the first health care system in the country to offer the training to all health care workers across all locations.

Novant Health is … leading the way by elevating trafficking into the forefront for all health care workers to understand how to effectively identify and respond to suspected trafficking and support survivors,” said Kristi Wells, Safe House Project’s CEO. “Many trafficking victims have pervasive health concerns or disabilities and are more vulnerable to traffickers.”

Novant Health operates facilities in cities known for high human trafficking. “Two of our areas are highly trafficked – Charlotte and Wilmington, which is a state port,” O’Neal said. “Step one is to get this content out there for all of Novant Health to start to have the awareness. Then, we can begin tracking the data, just as we do with COVID-19 patients.

“The topic of human sex trafficking is a whispered conversation that needs to be heard,” she said. “As a child in eastern North Carolina, I didn’t know what it was called or why things happened. I just knew it wasn’t right. I am thankful to work for an organization that is leading the way to empower team members and providers with the education and resources necessary to defeat this.

“I think life lessons – whether good, bad or ugly – are meant for a reason,” she continued. “And it may not be for us; it may be to help others. As part of my healing process, I share my story. That’s how I’ve gained the traction to move forward. I’m thankful to be here. I am so much stronger now.”


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Dr. Eric Eskioglu

“Our care teams on the front lines have a heightened awareness of the seen and unseen factors that can influence one’s health – including signs of abuse or human trafficking. Becoming the first health care system in the nation to implement H.O.P.E. Trafficking Training underscores our commitment to our mission of improving the health of communities, one person at a time. By training our teams to identify the risk signs of trafficking and how to facilitate protecting a patient if needed, our hope is that we can help people when they may be scared or unable to speak for themselves. I’m proud to be part of a health system that recognizes the importance of this work and encourage others to implement similar trainings so we not only can help people escape human trafficking, but continue work to eradicate it altogether.” – Dr. Eric Eskioglu, Novant Health chief medical and scientific officer.