Hanni Stoklosa, MD, MPH, of the Department of Emergency Medicine at Brigham and Women's Hospital (BWH), is a nationally recognized expert in caring for patients affected by human trafficking.
Over a decade ago, Stoklosa co-founded HEAL Trafficking, a non-profit with a mission to end human trafficking and support survivors through public-health based approaches.
In this Q&A, Stoklosa shares her motivations for addressing human trafficking, details a protocol for identifying and responding to potential human trafficking victims and shares her experiences extending the HEAL Trafficking resources across the globe.
What Made You Interested in Studying and Preventing Human Trafficking?
I grew up in a home of faith, so the need for one’s life to be dedicated to fighting injustice is integrated into my DNA.
In medical school, I chose the path of emergency medicine because I was drawn to the cases with highest acuity—those that were literally life or death.
This plays out both in my clinical world and in the cause I have dedicated my life to: Ending human trafficking.
Enslaving someone for one’s profit is the ultimate form of horrific violence and injustice. It hurts people around the globe, especially the most marginalized.
Can You Tell Us About HEAL Trafficking and How it Informs Your Research?
I co-founded HEAL Trafficking at a time when few people in health care were talking about human trafficking.
Our co-founding group believed the health sector has an opportunity and responsibility to respond to human trafficking and that public health approaches are needed to prevent it from happening in the first place.
We started HEAL Trafficking to respond to trafficking, equip health professionals and health systems to respond to trafficking, and shift the conversation from the limited criminal justice measures that are available to stop human trafficking to holistic public health reforms instead.
Today, HEAL Trafficking comprises over 4,000 health professionals and survivors of trafficking worldwide who have taught me so much and inform my clinical practice as well as research.
Why Do Health Settings Need Human Trafficking Response Protocols?
First, we know most trafficking victims have at least one if not multiple touchpoints with health care while they are being trafficked.
I cannot overstate how important it is for health systems to have guidelines in place for trafficking response.
Let me give an example: Imagine a victim of trafficking is brought to an emergency department on Saturday at 2 a.m. They were in a car accident.
The nurse notices they do not seem like just any other car accident patient. Maybe there is a controlling person in the room with them who is not really letting them talk, or they are being evasive about the details around the accident.
And despite how bad the accident was, no one called 911, and the patient was brought in via private vehicle.
The nurse has the training to notice the signs that indicate this patient could potentially be experiencing exploitation, such as trafficking.
This may be the only contact the trafficking victim has with people outside their situation to receive help.
But now what?
If the nurse does not have access to a clear, practical trafficking response plan—one that works at 2 a.m. on a Saturday as reliably as at 2 p.m. on a weekday—we risk losing a critical opportunity to break the cycle of violence.
What is the PEARR Approach and Why is it Important for Patients to Feel Empowered in the Process?
Like most clinicians. I was trained to think that screening for violence—for child abuse, domestic violence or trafficking—involved going down a list of "yes" or "no" questions.
If you think about it, that approach doesn’t make sense.
If you are a patient who is afraid, or feels shame about what has happened to you, you’re probably thinking to yourself, “Why would I share anything with this clinician? If I do tell this person, will things change for the better or for the worse?”
Rather than using the checklist approach, we recommend a structured conversation where the goal is to empower patients with information.
We call it the PEARR approach: Privacy, Educate, Ask, and then Respect and Respond.
Returning to the example earlier, if there is a person accompanying the patient involved in the car accident, maybe the nurse can find a moment to talk to that patient in private while taking them in for x-rays.
Once alone, the nurse might say something like, “I am your nurse and I care about your health and your safety. Some patients in our emergency department are in situations where they are afraid, and they feel like they can’t leave, maybe because somebody is profiting off them or threatening them or their family. I don't know what is happening to you, but I want you to know this is a safe place, and we have resources that can help. If you want, I can share more.”
The nurse can then ask about any specific concerns that may have arisen during their interaction with the patient.
The patient then guides the ensuing conversation. If the patient requests assistance, the nurse can respond by providing information about emergency services or providing a connection to a victim advocate. If the patient does not want assistance, the nurse should respect those wishes.
Each step of PEARR flips the script: The control needs to be in the patient’s hands as opposed to the clinician’s.
What are Some Future Directions HEAL Trafficking's Work Will Take?
There have been legislative developments that have come out of us creating these foundational resources for health systems.
The state of New York has mandated that diagnostic centers, which includes all hospitals, have trafficking plans in place. We would love to see more states adopt such laws.
Our toolkit is being used in over 50 countries globally and implemented in a range of hospitals, from large systems such as Mass General Brigham to a critical access hospital in Montana. We continue to expand the depth and breadth of our work with health systems globally.
Can You Tell Us About Adapting the HEAL Toolkit for Healthcare Workers in Brazil?
In the Brazilian state of Pernambuco, we collaborated with professionals from the health, social services, and justice sectors to adapt and translate the U.S.-based HEAL Trafficking Protocol Toolkit to the Brazilian context.
It has received positive user feedback thus far and has already been accessed in 17 Brazilian states and 53 Brazilian cities.
Given Brazil’s unified public health system (SUS), which reaches across the entire country, there is strong potential for this adapted toolkit to be scaled nationally as part of SUS efforts to strengthen trauma-informed, coordinated responses to trafficking in healthcare.
Any Final Thoughts for Mass General Brigham Clinicians, Researchers and Staff?
Each of us can make a difference in the effort to end human trafficking.
I encourage you to learn more and be prepared to help if the situation arises by checking out the resources on HEALtrafficking.org.
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