Nursing instructor shines light on human trafficking

Human trafficking is the fastest growing criminal enterprise in the U.S., said Stephanie Armstrong, R.N., Ph.D., an instructor in the MUSC College of Nursing.

It’s easy to see why, at least for those with no moral code.

“Once a criminal sells guns or drugs, they have to replenish their supply, but people can be continually exploited,” Armstrong said.

Armstrong’s work focuses on the intersection of human trafficking and health care. She wants to help health care professionals learn to recognize the signs that someone is a victim of trafficking and then know what to do about it. And that’s not easy, she acknowledges. Extricating someone from a human trafficking situation is complex, as the victim may be trapped in place by family ties, threats to their own or a loved one’s safety, mental trauma or substance abuse.

Victims also need extensive services afterward to help them reintegrate into society – services that aren’t yet always available.

But Armstrong is motivated by her passion for health equity and vulnerable populations, a sense of purpose that was instilled in her at the beginning of her nursing career.

Actually, Armstrong didn’t start out in nursing. She was a management consultant who worked on business process re-engineering. But she’d always had a love of anatomy and physiology, and she was a naturally nurturing person. She went back to school to become a nurse and began working in women’s health with new moms in northern Virginia.

Eventually her alma mater asked her to teach some clinical classes, and she discovered a love for teaching. Now, she teaches women’s and infants’ health at MUSC in the College of Nursing, as well as special sections on human trafficking.

“I teach students early in the semester about trafficking, and almost every semester, I have someone identify a victim while they’re in their women’s health clinicals,” she noted.

“I teach students early in the semester about trafficking, and almost every semester, I have someone identify a victim while they’re in their women’s health clinicals."

Stephanie Armstrong, R.N., Ph.D.

She’s also developing an interprofessional elective course on human trafficking that will be available this fall to students of all six colleges. 

Armstrong said human trafficking is a hidden crime that is all around us. Even the experts can’t say with certainly how many victims there are because of its shadowy nature. And although there has been more media exposure of this crime of late, there still remains much misinformation and misunderstanding of it.

“We’re definitely seeing more in the news – and that has been excellent in that it’s bringing about more awareness – but I don’t think people really understand how trafficking happens or who traffickers are or how to identify victims,” she said.

She likened public awareness surrounding human trafficking to the understanding of domestic violence 30 years ago. The two primary forms of human trafficking in the U.S. are sex trafficking and labor trafficking; of the two, sex trafficking attracts more attention. But labor trafficking can often be found in areas that require a lot of lower-paid workers, like those in the tourism industry or farm work.

She mentioned the visa system for low-skill seasonal or temporary workers, like housekeepers, landscapers, theme park or resort workers and restaurant staff, which she said can leave workers vulnerable to unscrupulous employers. Visas are valid only for a specific employer, so a worker who finds the work environment isn’t what was promised can’t just pick up and get a job across the street with another employer.

“If they leave that employer, then they are in the country illegally. They have to stay with that employer to be here legally. So the system needs some reform to help prevent this type of exploitation,” she said.

Armstrong has also advocated on Capitol Hill for a bill that would expunge a victim’s criminal record if the person was being trafficked at the time and was forced to commit crimes by the trafficker. Already, 44 states have such laws at the state level, according to the U.S. Department of State’s 2019 Trafficking in Persons Report.

“The reason this bill is so important is that in order for survivors to move forward and beyond their exploitation, they need to be able to make money in the legal job market, so they need employment. And it’s very difficult to obtain employment if you have a criminal record,” she said.

She was thrilled when S.C. Rep. Joe Cunningham’s staff contacted her a few weeks after her visit to say that he would cosponsor the bill.

But Armstrong is primarily focused on how health care professionals can address human trafficking. She works with HEAL Trafficking, an international multidisciplinary group that looks at human trafficking from a public health perspective. There, she serves on the group’s research and education and training committees and was also selected to serve on a  new committee to update the HEAL Trafficking Protocol Toolkit.

“One of my missions is to see all hospitals have a human trafficking identification and response policy and protocol in place,” Armstrong said. She found South Carolina hospitals lacking in such protocols when she surveyed them for her dissertation in 2018.

Between 50% and 88% of trafficking victims seek health care at some point during the time they’re being trafficked, providing an opportunity for intervention – if a health care provider recognizes the issue.

Armstrong said health care workers might observe physical signs of torture or abuse, like chunks of missing hair, missing teeth or bruises in various stages of healing. People who are being trafficked generally endure poor living conditions and may have food or sleep taken away as punishment; because of these conditions, they’re particularly susceptible to communicable diseases.

Providers might also notice that a patient is unwilling to make eye contact or looks constantly to a companion to provide all the answers. Increasingly, Armstrong said, traffickers are using technology to control their victims.

“The patient will come in and have their phone on speakerphone, and the trafficker will be listening to the entire interaction with the provider while they may be sitting in the parking lot,” she said. “It’s really important for health care providers to know this so they can try to separate the individual not only from an accompanying person but from any technology devices as well.”

Knowing how to respond can be tricky.

“We have to remember that our wheelhouse as health care professionals is to offer medical care and the opportunity for assistance – if they’re ready to receive it,” she said. “Not everyone is ready to leave their situation because there could be confounding factors.”

Those factors could include threats of harm to family members if the victim attempts to leave. A female victim might also have had a child with the trafficker.

Once they escape the trafficking situations, victims have extensive needs ranging from basic necessities like housing to help for severe mental trauma. Armstrong said the Tri-County Human Trafficking Task Force is working to understand what local community service providers offer, where the gaps are and what can be done to fill those gaps. 

It’s important for health care providers to understand how to provide trauma-informed, survivor-centered care so that they do not retraumatize victims and can help them to overcome the shame and stigma of their situations, she said.

Armstrong thinks back to her younger self. She was 19 – young, blonde, pretty and naive. She was working retail in Virginia when a man came in and told her he was working on a movie that was filming locally. He asked her for help to find a dress for his wife to wear to the wrap party. Armstrong spent an hour helping him browse. He didn’t buy anything but returned later, saying that because she had been so helpful that he’d love to invite her and a friend to the party and would send a limo to pick them up.

Armstrong was excited. “I was like, ‘We’re going to meet all these celebrities!’” she recalled. Luckily, an older and wiser co-worker suggested they get some information from the film company. After some phone calls, they discovered the movie he’d mentioned was actually being filmed in Mexico at that moment. Needless to say, Armstrong didn’t go to the fictitious party. She doesn’t know what might have happened had she gone, but she has her suspicions.

“Whatever it was, it wouldn’t have been good getting in a limousine where you can’t get out.”

But she realized how easy it had been for that man to get her to believe him and even to trust him. She understands how people can be deceived and fall prey to traffickers, particularly children.

Armstrong thinks it’s important that South Carolinians understand just how pervasive trafficking is in this state.

“It’s really throughout the state. It’s across the country. It’s everywhere, unfortunately.”