By David Lewellen
A former trafficking victim has a gynecology appointment. What will that feel like? What will be triggered?
Helping survivors cope with healthcare that seems routine to more fortunate people is the role of the medical advocate, a model being pioneered by Lotus Legal Clinic in Milwaukee. A trafficking victim who has been tossed around the medical and legal systems “might need someone to go with you, to protect your interests, and who understands the medical system,” said Rachel Monaco-Wilcox, an attorney and the founder of Lotus Legal.
The first advocate, Betty Seefeld, is a retired physical therapist. But chaplains, with their people skills and knowledge of the medical system, could also fill the role. “You need to speak healthcare,” Monaco-Wilcox said, “but you also need to be a passionate advocate of patients’ rights and protect someone whose rights are easily violated.” And, she added, advocates should have their own transportation, so they can give patients rides if necessary.
Seefeld said that her role is to “just be a listener, and when needed, to ask questions without taking over her perspective. You go whatever direction. It won’t be the same for one as it is for another.” In her life, she said, her medical background has come in handy for accompanying her her children and her aging parents on medical visits; advocating for trafficking victims has some resemblances.
But, she added, “it’s really important to stop and give them some time. So many of them have been in situations where they’re told what to do, and making choices is really hard.”
Former victims often struggle with sexually transmitted diseases, with drug or alcohol addiction, with past abortions. “It’s an educational process both ways,” Monaco-Wilcox said, both for the former victim and for medical providers, who can make “lots of rookie mistakes, like not paying attention when the patient goes into an episode of PTSD. It sets up a bad dynamic between the patient and the provider.” Or, if the patient does not speak English, “there are many layers of barriers to have a quality healthcare experience for someone who’s been sexually assaulted or trafficked.”
For instance, she said, too many medical professionals jump to the conclusion that a patient with a history of addiction should not get pain medications. “That just sets people off as not fair. They don’t want to be judged like that.”
Seefeld told a story of a pregnant survivor who said that pain medication was “the only thing keeping me from going back on heroin.” One doctor refused to treat the woman, but Seefeld helped her find another who was a good listener and a much better fit. If problems are anticipated, she said, it’s better to talk to the doctor or nurse in advance, so they know the patient’s issues.
Training for advocates includes the basics of human trafficking, with presentations by survivors, and separate training for undocumented victims. Some ethical issues are involved; if the patient tells a medical professional about a crime or about their own undocumented status, “what does the medical provider do with that information?” What if the victim is a juvenile? What if the victim has a chronic condition such as diabetes? Monaco-Wilcox told a story about a 17-year-old who used to regularly get dropped off at the emergency department when she had a diabetic crash after sex. Finally, the ER staff filed a third-party guardianship request.
Trafficking victims who are escaping the life may also have problems with housing, the legal system, child custody, and “every little thing is ten times as hard,” Monaco-Wilcox said. “But health needs to come first.”