Americans everywhere are being subverted into modern-day slavery, and it’s happening all around us. Laurie Charles, MSN, RN, SANE-A, SANE-P, CA-CPSANE, CHSE, discusses the role of health care providers in identifying victims of human trafficking and how everyone can play a part in the fight against it.
Lindsey Hendrix: Hello everyone, welcome to The Vantage Point. I’m Lindsey Hendrix. Human trafficking is one of those things that we don’t really think about happening in our own backyard, but it is. It’s happening right here in the Brazos Valley, and throughout Texas and the United States. I’m sitting here with Laurie Charles, who is a registered nurse and a forensic nurse with the College of Nursing. She’s also a clinical assistant professor. Welcome, Laurie.
Laurie Charles: Thank you.
Lindsey Hendrix: Before we begin, let’s define what human trafficking is.
Laurie Charles: Sure. In the easiest of terms, it’s modern day slavery. It is forcing somebody to work either without pay or without enough pay. Typically, it is in labor trafficking, like forcing people to work in a job against their will, but there’s also sex trafficking that we’re seeing a lot of, and that’s most of what I’m seeing in my practice.
Lindsey Hendrix: That is what we think about typically, is the sex trade, when we talk about human trafficking. What does this look like exactly? How does somebody get into human trafficking as a victim of it?
Laurie Charles: There are all kinds of reasons why people get into human trafficking, are forced into it. They typically have some kind of vulnerability and the perpetrator feeds on that vulnerability. People that are homeless, don’t have jobs, are hungry, they are really easy victims, and traffickers will say, “I’ll take care of you. I’ll feed you.” Or, they find the vulnerability like, the person doesn’t have somebody in their life that takes care of them and loves them. And so, they will use that vulnerability against the victim and force them into doing things they would not have wanted to do.
Lindsey Hendrix: The reason why human trafficking occurs, is it the money?
Laurie Charles: It is arguably one of the top three biggest illegal industries. There is the illegal gun trade and there’s drugs, and those two are huge. And of course, we can’t quantify them because it’s not like people talk about, “Hey, I made a million dollars last year selling guns illegally or selling drugs.” But if you think about human trafficking, you can sell a gun once, you can sell drugs once, but if I feed and water a human being, I can sell them repeatedly every day, over and over and over.
And so, when people say, “Oh, it’s the third biggest industry,” we don’t know. What I do know is it’s sustainable. As long as they continue to house and feed them, they can sell that person over and over and over, and make who knows how much money off of that person.
Lindsey Hendrix: Who are the perpetrators that we know of? What do they look like?
Laurie Charles: They look like everybody else. We have seen perpetrators from all races, all religions, males and, sadly, I’ve seen a lot of females. We have also seen family members trafficking their children.
Lindsey Hendrix: That is so sad. Is there a place in Texas where this is most prevalent, or would you say it’s pretty even across the board?
Laurie Charles: It’s happening everywhere. Whether or not we are doing a good job as professionals to recognize it is what the issue is. If you look online, there are stories in really small-town Texas, you know, Mexia, Texas. There are stories coming out of Bryan-College Station, San Antonio, Houston. I mean, all the huge urban places, there’s definitely sex trafficking happening, but it’s happening all over the state.
Lindsey Hendrix: I think typically, when we think about human trafficking, most people might think bringing people illegally over the border to come work and do labor, and also sexual exploitation. Is that where the majority of this happens, or is it also a domestic issue?
Laurie Charles: In my experience, it’s almost completely a domestic issue. Absolutely, people are brought into the country to work illegally in the sex trade or labor, like migrant workers, that kind of stuff. We’re definitely seeing that. Factory workers, carnivals, we’re definitely seeing that, but in my experience, it is Americans trafficking Americans to other Americans.
Lindsey Hendrix: That blows my mind. I can’t believe that happens. As a health care professional, what is your duty to make sure that human trafficking is not an issue, or how does a health care professional intervene?
Laurie Charles: We have to, number one, know that it exists. Because if you don’t think pink elephants exist, you won’t be able to see the pink elephant that’s sitting in the room with you. And if you don’t think that human beings can do these horrible acts to other human beings, you’re not going to recognize it, and you won’t ask questions that are pertinent to people that are being victimized, who oftentimes are begging for somebody to just ask if they’re okay.
Lindsey Hendrix: At what point do you normally see the victims of human trafficking? Is it because something happened while they were being exploited, and they got injured, or hurt and they’re coming to you? At what point do you normally see them?
Laurie Charles: That is when we see them. In 2014, researchers Lederer and Wetzel looked at human trafficking victims, and they actually spoke to people who had survived human trafficking. It was almost 86 percent of victims said now that they’ve survived trafficking, they’re out of trafficking, they said, “We saw health care professionals while we were being trafficked.” When they said that, what that meant was, they were going into the emergency department for broken bones or other health care related issues, sexually transmitted infections, pregnancy, miscarriages, those kinds of things, and people weren’t asking.
They were going to sexually transmitted disease clinics, they were going to urgent care facilities. What that told me was we were missing it. They were coming, 86 percent. So, what that means in my head is every single patient could potentially be a trafficking patient, and I need to ask the question. If we don’t ask the question, then they don’t have the opportunity to give us an answer that can allow us to help them. That causes me to not sleep at night.
Lindsey Hendrix: I imagine so. Are these victims coming to you with, I don’t know what you would call them, their handlers? And what kind of position does that put them in to actually disclose what is going on?
Laurie Charles: That’s a really good question because, yes, they are typically coming with either their trafficker, the person that is selling them or a handler, oftentimes called the bottom, somebody who is in control and is running the stable. That’s a term that traffickers use to dehumanize their victims. It’s like a stable of horses. That’s what they call them, and so they’re not even people.
They will come in with somebody, oftentimes the trafficker or a handler, and so that person routinely will answer all the questions. They will talk like they’re a family member, but when you look, they don’t look anything alike. And they won’t ever allow the patient to be there alone, because of course, they don’t want that patient talking about what’s going on. Yes, they want their broken bone taken care of, or whatever their sexually transmitted infection is, or something like that, but they don’t want any other information to be let out. So, they don’t let them be alone.
Lindsey Hendrix: I know this is a terrible thing to say, but I imagine that the traffickers do want their victims to get health care so that their “property” is still fit to do the work that they’re there to do.
Laurie Charles: That’s exactly the right way to think of that because that is the way the traffickers are thinking of it. We had a situation in San Antonio, and the trafficker—he’s been prosecuted—he routinely took his stable of women to a clinic to get health care. That’s what he did all the time, so he could continue to sell them to other people.
Lindsey Hendrix: That’s crazy. What kinds of stories do you have, or experience with this issue, here in Texas? I know you’ve been a registered nurse, you’ve been working in forensic nursing for a long time, do you have any surprising stories to share?
Laurie Charles: Sadly, yes. I ran the pediatric forensic nursing program in San Antonio for 16 years. We have an absolutely amazing child abuse pediatrician as our medical director there, Dr. Nancy Kellogg, and so we were very blessed. The very least experienced forensic nurse that we had on the team had been a nurse for, excuse me, a forensic nurse for nine years. Every person on the team saw approximately 250 children a year, just absolute experts. Absolute experts. Not a better team, and I know that’s biased, don’t care. Just an amazing forensic nursing team.
A girl came in, who was a very young teenager, and she described being sexually assaulted by two men. The nurse took care of her, did everything she should do, reported to Child Protective Services, reported to law enforcement, collected evidence, and sent her home with her mom and her aunt.
A year later, this child comes back into our hospital because she was rescued in another town where she was found naked in a room full of men, where she was to perform sex acts on all those men. When she came back to us, we look up every patient to say, “Have we seen them before for sexual assault?” And we had seen her before. That gave us pause, you know, was there something we could have done better? Was there something we missed?
I called my friend, Chuck Paul, who was at that time a Child Protective Services worker, and I said, “Did we miss something?” And he said, “Yes.” I had to take a deep breath, and I sat down and had my pen ready, because I’m thinking, this is just going to be something huge and amazing, and I said, “What did we miss?” He said, “You should have asked how she met those men that assaulted her last year.”
Lindsey Hendrix: It seems like such a basic question.
Laurie Charles: Exactly.
Lindsey Hendrix: Easy to overlook.
Laurie Charles: You don’t have to be highly educated to ask that question. I said, “How did she meet those men?” Her mom. Her mom sent her to that house and sold her to those two men for a $200 money order. When we first saw that little girl, she didn’t tell the nurse that stuff, but also, we didn’t ask. With this new information, we decided to sit down as a team and go over that case. What could we have done better? Because that nurse did a great job. She collected evidence, she reported appropriately, she did all the things she should have done, but we still missed it.
We decided as a team, how are we going to do a better job, how are we not going to miss the next person? We educated ourselves with our medical director, we collaborated with community partners. Kirsta Melton, who is now with the Attorney General’s office, she became our human trafficking district attorney in Bexar County, worked closely with Chuck Paul, who was with CPS, and with all our law enforcement agencies for, how do we educate ourselves better, and how do we do a better job?
They now have multidisciplinary team meetings in San Antonio around human trafficking to talk about what do we do to help and support this child, and then anybody else around the situation. That little girl, when we saw her a year later, by then her older sister had been trafficked, she had been trafficked and her two little sisters. Mom sold everybody in that house. Could we have prevented that if we would have just asked, “Hey, how did you meet those men?” And then gone down that road, because I think if we would have asked that little girl, she would have told us.
Lindsey Hendrix: Mm-hmm.
Laurie Charles: It’s such an easy question, but you have to see the red flags. If listeners want to know about that, they can go to the Attorney General’s website and they have a great list of red flags, and they talk about “Be the one.” They have a fantastic video on what you can do in the community to look for the potential red flags of trafficking, and then what do you do when you see those things.
Lindsey Hendrix: We’ll be sure to link to that resource in the show notes so everybody can look for those key red flags to look for.
Laurie Charles: Thank you.
Lindsey Hendrix: I imagine health care professionals are probably one of the only group of people that a lot of victims of human trafficking will see outside of their work and their handlers and the traffickers. So, it’s incredibly important to educate the health care workforce about what to look for. What is Texas A&M doing to make sure that that happens?
Laurie Charles: Texas A&M is doing some great things. We created a forensic nursing program within the College of Nursing. There are five of us on that team, we’re all forensic nurses, and we have a master’s program in forensic nursing. The students are registered nurses, and they come in and they will get all of the usual master’s level education in pathology and pharmacology, all of that. But they’ll also get the forensic courses.
In that, there’s actually a human trafficking elective, a one credit elective, and I teach that course. We’ve taught it twice already, and in each cohort, one student actually was able to recognize trafficking at their own facility and tell everybody else and then intervene appropriately to help that patient.
Lindsey Hendrix: So, you’re actually seeing this in practice in the community, and you’re preventing people from these life-threatening, horrible, traumatic situations. That’s so great.
Laurie Charles: Could not be more excited about that because when we created the elective, I just wanted people to have a little bit more education about human trafficking. But then seeing, wow, we are making any incredible impact. We also host human trafficking conferences around the state of Texas, and we’ve held three so far. I have three scheduled: Abilene, the beginning of June and Victoria in September and San Antonio in October. We educate doctors, nurses, social workers, anybody else in the community and law enforcement, and we provide continuing education hours to all of those people.
One of the prior conferences we had in Lufkin, a parole office came up to me and said, “One of my kids is being trafficked!” I’m like, “Okay!” She was like, “What do I do?” And I said, “Well, she’s on probation. You can mandate she come in to see you.” She’s like, “Yes! Okay, let’s come up with a plan.” That’s exactly what was happening. She just thought that she had this child who was acting out and had acting out behaviors and was defiant and everything. But when she went to the court, she realized, “Oh my goodness, there’s a reason for her behavior, and it’s trafficking.” And so, she was able to intervene in that situation too.
You just don’t know the impact that education and training has on people in the community, but I do know that it has directly, positively impacted survivors of trafficking.
Lindsey Hendrix: As members of the community, the general population, what can we do to both prevent human trafficking, to prevent ourselves and our children from becoming victims, and then also identifying current victims of human trafficking?
Laurie Charles: Prevention things; Become educated, become aware, know that it happens, learn about the signs and symptoms, and you can do that on the Attorney General’s office website. And pay attention to your children and what they’re doing and the apps on their phones. There’s all kind of apps. There’s a calculator app and you wouldn’t think anything of it, it’s a calculator. But when you look, your kid has two calculators because one’s a calculator and the other one covers up these apps. There’s all different kinds of apps. You can go into battery usage on your child’s phone and see what apps are using the most battery, and then you could figure out where these apps are.
One of the most important things I heard from one of our speakers at the trafficking conferences, Kirsten Melton, she talked about, you would never let a stranger knock on your door and come in and talk to your kid for hours at end. You would never allow that, but yet, we do it every day through gaming.
Lindsey Hendrix: Oh, right.
Laurie Charles: Kids are online, and they have somebody talking in their ear for five, six hours a day.
Lindsey Hendrix: I imagine they get a lot of information out of the children about what matters to them, what struggles they’re having, people’s names, all kinds of information that they can use.
Laurie Charles: Where are the gaps? What do I need to fill in this child’s life? What is the thing that that kid needs? Is it love, is it attention? What do they need that I can fill that I can pull that child away from their family, and sell them repeatedly?
Lindsey Hendrix: We talk about gaming specifically, but I imagine social media also.
Laurie Charles: Very much so, and kids have their account open to everybody, it’s not private. Somebody sends a friend request, they accept it. They’ve never met this person, they have no idea. We have seen children that are lured away by people from other countries, all kinds of terrible and very scary things.
Lindsey Hendrix: So, as a parent, monitor your children’s online activity, talk to them about the dangers.
Laurie Charles: Yes.
Lindsey Hendrix: What else can we do?
Laurie Charles: Ask questions and then actually listen. One of my friends who is a trafficking survivor, when I said, “What could health care have done?” Because she said she came in many times. I said, “What could we have done?” She said, “Ask if I’m okay, and then actually listen.” That’s not a difficult question to ask. But it is difficult when I’m very busy, and I have to go take care of the next patient, and to stop and pay attention to this patient right now, and show them that I care, and be present when they give me the answer.
Lindsey Hendrix: And that’s what we’re teaching our Aggie nurses to do, right?
Laurie Charles: Very much so, very much so. We’re teaching our Aggie nurses to be nurse leaders, not just nurses, but the most amazing nurses who are leading the way in health care.
Lindsey Hendrix: So, we went over how to prevent human trafficking, you gave us the list that we can look at for potential red flags. Is there any other information that you want our listeners to know?
Laurie Charles: There are all kinds of agencies that can help. If you are out there somewhere, and you think trafficking is going on, get safe. Do not intervene if you’re a normal person. You know, let law enforcement handle that situation. But you get safe, and call. You can call law enforcement, you can call the National Human Trafficking Hotline, and we can give that number also. But say, “I am concerned for trafficking.” When you talk to law enforcement, make sure they know that.
There are other things. There’s TraffickCam. It’s an app on the phone. Every time you go stay in a hotel, you can take a bunch of pictures of the hotel. Because law enforcement, when they’re looking at these escort service sites and stuff, there’s pictures of hotel rooms, but they don’t know where that is. TraffickCam, if we say, “Hey, I’m at this hotel and here are all the pictures of my hotel room,” you tell them your room number, you load it up to the app, that helps law enforcement. So, maybe the next trafficking victim, they can go, “We know that furniture because it’s in that hotel chain in that town.”
Lindsey Hendrix: So, any time you go to a hotel, not just if you’re suspecting that something is going on? Just go ahead and take photos, upload it to this database, that’ll help law enforcement?
Laurie Charles: Yes. So, I’ve been doing that for quite some time. And just be aware, it is happening. We went to a forensic nursing conference in Denver. We were in a downtown, five-star, beautiful hotel in Denver. It was, like, 1,500 forensic nurses are there, hyper aware. And so, I’m standing, speaking to another forensic nurse, and I have no idea what she said to me because I watched a man walk in with two young girls who—we were in Denver in October and they were dressed very inappropriately. They were dressed in very high heels, tiny little skirts, tiny little tops, a lot of makeup and just big, big hair.
It just immediately concerned me. As a pediatric nurse, I knew they were probably 13, 14 years old. They were very young girls and he was an adult male. He told them to go up to the eighth floor and do whatever they were told to do, and then meet him back downstairs. So, I did not intervene, because I have no idea what weapons he has or if there’s anybody else there. I ran out to the front desk and I said, “My name’s Laurie Charles, I’m a forensic nurse. I’m here for a forensic nursing conference and I think trafficking is going on in your hotel.”
Lindsey Hendrix: Oh my gosh.
Laurie Charles: I thought, “They are going to think I’m absolutely bonkers.” He was like, “We just had a training the other day.” And so, he called his manager, the manager called the police, I gave my business card and I said, “Do you want me to stay? What do you want?” He said, “No, no. We got it.” And I never heard a thing again. I was disappointed, because I really thought, “Wow, I really hope I impacted and something happened.” Just a couple months ago, one of the other colleagues at A&M, Dr. Nancy Downing, she is actually on the board of the International Association of Forensic Nurses. She said, “You know, we just talked about this. In Denver, one of our forensic nurses called the police, and they actually did a sting, and they arrested a bunch of people.” I’m like, “That was me!”
Lindsey Hendrix: Oh, wow.
Laurie Charles: So, you never know the impact that you can have. She was going to send me the news stories because I was really excited. So, report. What’s the worst thing that’s going to come out of that?
Lindsey Hendrix: Right.
Laurie Charles: Right? I reported, and it was nothing.
Lindsey Hendrix: Would that be the process that you would recommend if you’re in a hotel? Go to the front desk? What if they have hesitations? What if they say, “No, there’s no way.”
Laurie Charles: Call the police. Call the police or the Human Trafficking Hotline. And, number one, get yourself safe. The state of Texas has some fantastic laws regarding human trafficking and so do we in the United States. But the hotel that is allowing it to happen, and they know it’s happening, and we can prove, they are just as at fault as the trafficker. The Uber driver or the Lyft driver that is driving the victim around to the out calls, they are just as at fault. They can be prosecuted also. We definitely need to provide education to the hotels, to all those companies, Lyft, Uber, all those kinds of things. Tattoo artists who are putting tattoos on people that may or may not want that tattoo. There was just a story the other day that they were having education and training for the tattoo artists in town about certain tattoos, and what you need to look for. Things like barcodes.
Lindsey Hendrix: Oh wow.
Laurie Charles: Dollar signs. For some reason, traffickers really like roosters. I’m just going to leave that like that. And so, those kinds of tattoos you need to pay attention to that, and that is a potential sign of human trafficking. Anybody, anywhere, we need to educate them.
Lindsey Hendrix: People might be hesitant to call law enforcement because they fear, what if they’re wrong?
Laurie Charles: Mm-hmm.
Lindsey Hendrix: Should they be hesitant to do that?
Laurie Charles: If you are hesitant to call law enforcement, call the National Human Trafficking Hotline and say, “I have concerns. I don’t know.” And it is okay to not know. I would rather report 100 times and not be right 100 times, but what about that one time that you were right and nobody knew about it? You could potentially be saving somebody.
Lindsey Hendrix: I’m assuming it’s an anonymous tip.
Laurie Charles: It can be.
Lindsey Hendrix: Okay.
Laurie Charles: It can be.
Lindsey Hendrix: Because I’d wonder, if you’re out in a hotel lobby and somebody sees you calling the police and it’s the trafficker, the repercussions could be scary. Do you recommend going back to your room? Where do you make sure that you do that safely?
Laurie Charles: Yeah, get safe. Make sure you’re safe and secure. You have to take care of yourself first, nobody else can do that like you can. Take care of yourself and get safe, and then make the phone call with as much information as you can. But at least give the information.
Lindsey Hendrix: If people are hesitant to call local law enforcement, they can also contact the national hotline, what’s that phone number?
Laurie Charles: 1-888-373-7888. That’s the National Human Trafficking Hotline. You can also text 233733. You can either text HELP or INFO. It’s 24 hours a day, they have more than 200 language interpreters that are willing and able to help if victims are calling or somebody is concerned and wants to report. The website is humantraffickinghotline.org.
Lindsey Hendrix: Well, we’re going to link to all of the resources that Laurie gave us, the 800 numbers, the checklist of red flags to look for. Are there any other online educational resources that you’d like for us to share with our listeners?
Laurie Charles: We will definitely link our human trafficking conference registration across the state so people can go to that if they’re interested.
Lindsey Hendrix: Fantastic. Well thank you so much, Laurie, for joining us. This information is incredibly important. It just amazes me that this is happening everywhere, and I hope this is empowering people to intervene and help really address the issue.
Laurie Charles: I absolutely hope that’s what happens, too. Thank you.
Lindsey Hendrix: Thank you everybody for listening to this edition of The Vantage Point. Tune in next time.
Call the National Human Trafficking Hotline at (888) 373-7888, 24/7, for help in English, Spanish and 200 more languages
SMS: 233733 (Text “HELP” or “INFO”)