Latest / The Science of Skin / Signs of Trafficking: Identifying Victims in Medical Settings

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Signs of Trafficking: Identifying Victims in Medical Settings · The Science of Skin

• 0:05
  SPEAKER_01: Hi everyone, I'm Dr.
• 0:06
  SPEAKER_01: Patty Ferris.
• 0:07
  SPEAKER_01: I'm a board certified dermatologist, and I'm your host for this episode of Skin Care Confidential.
• 0:13
  SPEAKER_01: As you all know by now, this is an outreach of our medical meeting, the Science of Skin Summit.
• 0:18
  SPEAKER_01: We're very excited this year's summit's going to be held in Austin, Texas.
• 0:22
  SPEAKER_01: It's on September the 5th through the 7th.
• 0:25
  SPEAKER_01: I get a little confused because we keep jumping from November to September.
• 0:28
  SPEAKER_01: Now we're back to September.
• 0:30
  SPEAKER_01: Anyway, it's the weekend after Labor Day.
• 0:32
  SPEAKER_01: If anybody's interested in taking a deeper dive into skincare and some of the latest trends that are happening in the science of skin, for example, longevity and regenerative medicine.
• 0:43
  SPEAKER_01: We've got all kinds of really exciting sessions this year.
• 0:46
  SPEAKER_01: So today I'm really excited about this podcast because, you know, Merrick, I'll just go straight up and be as honest and candid as I can.
• 0:55
  SPEAKER_01: It's very unusual for me to talk about a subject that I really know very little about.
• 1:00
  SPEAKER_01: So I always learn a lot from these podcasts, but I think today I'm particularly going to learn a lot because we're going to be discussing the subject of human trafficking, which is something that as doctors and as dermatologists, I think we don't know enough about.
• 1:16
  SPEAKER_01: But I want to start by introducing my audience to Merrick Elias, who I just met not long ago in an advisory board, and we had a great time working together.
• 1:25
  SPEAKER_01: He's a board-certified dermatologist, a clinical assistant professor at Nova Southeastern University College of Osteopathic Medicine, as well as the Orlando College of Osteopathic Medicine.
• 1:36
  SPEAKER_01: He's a volunteer associate professor in cutaneous surgery at the University of Miami.
• 1:43
  SPEAKER_01: So he's Miami-based.
• 1:44
  SPEAKER_01: He's a Florida guy.
• 1:46
  SPEAKER_01: He loves all sports.
• 1:48
  SPEAKER_01: I can tell you that.
• 1:48
  SPEAKER_01: I've only spent a little time with him, but he's definitely a sports enthusiast.
• 1:52
  SPEAKER_01: But he got his degree at Cornell University, his bachelor's, that is, and uh attended the University of Miami where he did a post-baccalaureate pre-medical program.
• 2:03
  SPEAKER_01: He then earned his doctor of osteopathy from Nova Southeastern University in Flor Fort Lauderdale.
• 2:10
  SPEAKER_01: And then he did a fellowship, and it's an interesting fellowship you did in non-invasive diagnostic imaging techniques for pigmented lesions.
• 2:17
  SPEAKER_01: I'm surprised you didn't end up a MO surgeon because you did a lot in cutaneous surgery.
• 2:21
  SPEAKER_01: You were at Sloan Kettering for uh some time during that uh fellowship.
• 2:27
  SPEAKER_01: And then you trained extensively in dermatology and cutaneous surgery.
• 2:31
  SPEAKER_01: You're in practice with your brother, you have which is really cool.
• 2:34
  SPEAKER_01: You guys have a practice, the Elias Brothers called Elias Dermatology.
• 2:38
  SPEAKER_01: And they're very passionate, not to mention about everything in dermatology, but about raising awareness with skin cancer as well as sun protection.
• 2:47
  SPEAKER_01: So, with that, I'm gonna open up by asking the question: how did you become interested in human trafficking?
• 2:53
  SPEAKER_01: Is that something you might have seen in your practice?
• 2:56
  SPEAKER_00: So, uh first let me say thank you for that great introduction.
• 3:00
  SPEAKER_00: Thanks for having me on this great podcast.
• 3:02
  SPEAKER_00: I'm gonna give another plug to the conference in Austin because it's a great conference.
• 3:06
  SPEAKER_00: I've heard a lot about it.
• 3:07
  SPEAKER_00: I spent some time recently with your colleague Ted Lane, and he was giving me a kind of a heads up on all the lectures, um, all the innovative topics.
• 3:14
  SPEAKER_00: We've talked a lot about secretomes and exosomes and some of the other things, but today we are gonna talk about human trafficking.
• 3:21
  SPEAKER_00: And it's something, believe it or not, when I did my research on this, that we all see every day, and most of us don't know it.
• 3:29
  SPEAKER_00: So it's a it's a hugely important topic.
• 3:32
  SPEAKER_00: It's something that we need to raise awareness, not just in the house of medicine, but even as dermatologists, as we'll talk about.
• 3:38
  SPEAKER_00: Um, and and it's scary how much how prevalent this is and how little we discuss it.
• 3:43
  SPEAKER_00: Um, you mentioned you know pigmented lesions and most surgery, um, aesthetic products, all those are important, but we also have to remember the person who's in front of us.
• 3:53
  SPEAKER_00: So that person may be going through God knows what.
• 3:56
  SPEAKER_00: And we'll dive in in a minute here.
• 3:58
  SPEAKER_01: Yeah, so you know, you bring up such a great point.
• 4:02
  SPEAKER_01: You know, we tend to sometimes look at the patient as the disease or as the condition that we're treating, and sometimes miss the big picture.
• 4:10
  SPEAKER_01: Um, how how does it happen, trafficking?
• 4:13
  SPEAKER_01: Let's start sort of at the experience of the person who's being trafficked.
• 4:18
  SPEAKER_00: So, you know, we talk about trafficking, we can break it down, and this is really um going to be a synopsis of a bigger lecture, really could be even a symposium.
• 4:26
  SPEAKER_00: There's so many components to it.
• 4:28
  SPEAKER_00: Trafficking, we think about, you know, under the umbrella of human trafficking, there's child trafficking, there's actual labor trafficking, there's sex trafficking.
• 4:36
  SPEAKER_00: So, you know, when you see a patient who's a landscaper, they may be being trafficked.
• 4:40
  SPEAKER_00: When you see a housekeeper, they may be being trafficked.
• 4:43
  SPEAKER_00: It's not just the traditional you think of a homeless child or runaway.
• 4:47
  SPEAKER_00: Um, so um we the first thing we want to do is we want to be able to identify what is who are these patients, who are these people in front of us.
• 4:56
  SPEAKER_00: There have been studies done that show um trafficking victims, and they, you know, the ones that have been recovered and saved, and they go through and they ask them, and 80 to 90 percent of them say they've seen a physician in the last year.
• 5:08
  SPEAKER_00: Over 60% of them were seen in emergency rooms.
• 5:11
  SPEAKER_00: And when you pull the physicians and and the ancillary um practitioners in emergency rooms and doctors' offices, somewhere between only 10 and 20 percent say they've even ever seen a patient with that.
• 5:22
  SPEAKER_00: So there's a huge, huge gap there, a gap in knowledge, a gap in awareness.
• 5:27
  SPEAKER_00: Um, before we even talk about how we're gonna help these patients, we don't even realize that almost every day we see them.
• 5:33
  SPEAKER_00: Um, traffic has been reported in every single state in the country.
• 5:38
  SPEAKER_00: When I've traveled, when I um flew to Nashville when I recently, the airport in Fort Lauderdale, they have trafficking information in the bathrooms.
• 5:46
  SPEAKER_00: The PA says it on the overhead speakers.
• 5:49
  SPEAKER_00: I was in Miami Airport for an international flight recently, same thing.
• 5:52
  SPEAKER_00: So it's they're doing a good job in the airports, but in my house of medicine, I don't think we're doing that good of a job.
• 5:59
  SPEAKER_01: So how does it happen?
• 6:00
  SPEAKER_01: Um I what I know there's some.
• 6:03
  SPEAKER_00: There's there's acts.
• 6:04
  SPEAKER_00: Right.
• 6:04
  SPEAKER_00: So there's there's very specific steps, right?
• 6:06
  SPEAKER_00: So there's the act, right?
• 6:08
  SPEAKER_00: So am I gonna you know get you?
• 6:10
  SPEAKER_00: Am I gonna transport you?
• 6:11
  SPEAKER_00: Am I gonna hide you?
• 6:13
  SPEAKER_00: Am I gonna promise you things?
• 6:14
  SPEAKER_00: Am I gonna say that you know your life will be better?
• 6:17
  SPEAKER_00: Or am I gonna threaten you?
• 6:18
  SPEAKER_00: Am I gonna take you and you know, say, I'm gonna kidnap you?
• 6:22
  SPEAKER_00: Am I, you know, all these different things.
• 6:24
  SPEAKER_00: So then there's that.
• 6:25
  SPEAKER_00: That's the means.
• 6:26
  SPEAKER_00: And then the end point is, you know, okay, what's the purpose?
• 6:29
  SPEAKER_00: Am I exploiting you sexually?
• 6:31
  SPEAKER_00: Am I, you know, harvesting your organs?
• 6:34
  SPEAKER_00: Am I making you into uh slave labor?
• 6:37
  SPEAKER_00: Am I putting you into work?
• 6:38
  SPEAKER_00: So, you know, when when we find the situation, it could be anyone, you could be down on your luck, you could be working in an adult entertainment club, you could be on the streets, you could be looking for a job.
• 6:49
  SPEAKER_00: And the person ahead of you exerts some kind of power, some kind of authority over you.
• 6:54
  SPEAKER_00: They make these promises that you either fall for or they forcibly execute, you know, execute those promises and take you.
• 7:01
  SPEAKER_00: And then, you know, it's very hard when these people get into this situation, they don't know what to do, they don't know how to get out of it.
• 7:06
  SPEAKER_00: Nobody's trained this.
• 7:08
  SPEAKER_00: We don't learn about it in high school, we don't learn about it in elementary school.
• 7:11
  SPEAKER_00: Our parents generally don't talk to us about what would happen if so, you know, we want to raise awareness not just as physicians but as parents too.
• 7:20
  SPEAKER_01: Yeah, absolutely.
• 7:22
  SPEAKER_01: So when when these patients, or I should say these people, are trafficked, they can be trafficked obviously with the number of goals in mind from the person who's doing the trafficking.
• 7:34
  SPEAKER_01: How do they end up in the emergency room?
• 7:36
  SPEAKER_01: How that obviously seems to be a place where they're going the possibility for intervention is high.
• 7:43
  SPEAKER_00: Right.
• 7:43
  SPEAKER_00: So let's say uh an individual was taken from a truck stop or a massage parlor or one of those facilities, they they they're in the life, as they like to call it, right?
• 7:53
  SPEAKER_00: And they're going through it.
• 7:54
  SPEAKER_00: But at some point, there's evidence of it could be bruising if it's a if it's a sexual trafficking, there could be genital bruising, there could be well visits, there could be acne.
• 8:04
  SPEAKER_00: We want to talk about dermatology.
• 8:06
  SPEAKER_00: You know, if this is a person being put into the sex trade, we think about cosmetic dermatology to make people beautiful, but there's also making people beautiful for an ulterior motive.
• 8:15
  SPEAKER_00: You know, the business means if there's a pimp or somebody like that, they're gonna make sure if they're a little bit older, maybe they need a little Botox, maybe they need to have um filler, maybe they have bad acne, maybe they have an STI.
• 8:29
  SPEAKER_00: You know, so all these are reasons they would report to an emergency room.
• 8:33
  SPEAKER_00: When they come to the emergency room, oftentimes they don't have insurance, or there's somebody who's paying cash.
• 8:41
  SPEAKER_00: This is uh one of the ways to tip things off.
• 8:43
  SPEAKER_00: Now we have a lot of patients that pay cash, right?
• 8:45
  SPEAKER_00: Um, but someone who comes with maybe an older gentleman, um, it's a younger female, she's not allowed to speak.
• 8:53
  SPEAKER_00: Maybe if someone has two, three cell phones with them, they're very vague about their address, where do they live, what kind of, you know, they're not answering questions, they just want to be paid.
• 9:02
  SPEAKER_00: And typically the person who's um the captor, if you will, doesn't separate from the patient or the victim.
• 9:09
  SPEAKER_00: So that's an important thing we'll talk about a little bit later on.
• 9:12
  SPEAKER_00: How to separate them, what means once you've potentially identified this, how do we then say, okay, we have to break them apart?
• 9:21
  SPEAKER_00: And it might not be the first visit.
• 9:23
  SPEAKER_00: You know, these these victims will go back, you know, they'll have vaginal bleeding, or they'll have a sore or an ulcer, or they have a cracked rib because they got hit, or they got, you know, violently thrown to the ground, they have a concussion.
• 9:36
  SPEAKER_00: So there's a lot of reasons why they would present to an emergency room, but there's also a lot of reasons they present to almost anybody, gynecologists, primary care, dentists, you know, so the whole house of medicine and obviously dermatology.
• 9:48
  SPEAKER_00: Um, oh, there's there's a lot of tattooing that goes on, so we can talk about that as well.
• 9:53
  SPEAKER_01: Yeah, I saw some of the pictures from your lecture.
• 9:55
  SPEAKER_01: Those were so interesting.
• 9:57
  SPEAKER_01: So talk about obviously we do lots of tattoo removal.
• 10:01
  SPEAKER_01: We are there things in tattoos that might tip us off as to those being related to trafficking.
• 10:08
  SPEAKER_00: So absolutely.
• 10:09
  SPEAKER_00: I mean, these are some of the things, you know, we talk about the physical signs, we talk about the emotional signs.
• 10:14
  SPEAKER_00: So a patient is down on their luck, their eye contact is kind of like this, you know, they have signs of abuse or neglect.
• 10:22
  SPEAKER_00: Um, maybe, you know, you look at them and they're like, they have six hotel keys, you know, attached to their wallet or or their purse.
• 10:30
  SPEAKER_00: Um, they talk in a certain manner.
• 10:32
  SPEAKER_00: They're either talking really fast like this, or they're very glum like this.
• 10:36
  SPEAKER_00: Um, they'll talk about their time, their the I used the word earlier, it's in it's in their life.
• 10:40
  SPEAKER_00: It's it's it's just our way.
• 10:42
  SPEAKER_00: Uh hypersexualized 11-year-old, you know, is all that.
• 10:46
  SPEAKER_00: But then we talk about the age groups.
• 10:48
  SPEAKER_00: We say females 18 to 20 are probably the most common, but we see all age groups, all genders, every every single person, male, female, young, old, is at risk and and can be trafficked and do get trafficked.
• 11:01
  SPEAKER_00: So the tattoo signs are often possessive signs.
• 11:05
  SPEAKER_00: It could be a barcode on the back of the neck, it could be the name of their captor inside their lip tattooed.
• 11:11
  SPEAKER_00: The biggest one are crowns.
• 11:13
  SPEAKER_00: You know, she's mine, he's my daddy, he's you know, the you know, the the idea of his and hers tattoos, um, all these signs of possession.
• 11:23
  SPEAKER_00: So I always implore any of my colleagues, cosmetic surgeons, dermatologists, even our spa owners, anybody that does laser tattoo removal, do these for free.
• 11:33
  SPEAKER_00: If you see a victim or someone who was a victim of being in the life, just do it for free.
• 11:38
  SPEAKER_00: Just take care of them, help them feel a sense of normalcy.
• 11:41
  SPEAKER_00: You are doing such a huge important thing for that patient population.
• 11:45
  SPEAKER_00: Um, and no good deed goes unpunished.
• 11:47
  SPEAKER_01: So it's it's really you have to have your antenna up.
• 11:49
  SPEAKER_01: I do think the ASDS has a program where they provide free care for people who are interested in having tattoo removal.
• 11:56
  SPEAKER_01: So that's certainly something that I think is a great idea.
• 12:01
  SPEAKER_00: Even more awareness is a lot of times we talk about, you know, hey, I just bought a new tattoo laser, and who do you market to?
• 12:06
  SPEAKER_00: The tattoo parlors.
• 12:08
  SPEAKER_00: But when you're in there, we should also educate them on someone comes in with a man paying cash the same way, the same story, right?
• 12:15
  SPEAKER_00: With a younger girl, and they want this kind of a tattoo.
• 12:17
  SPEAKER_00: And they're pretty elaborate.
• 12:18
  SPEAKER_00: It's not just like a little like I drew it with a pen or a tattoo pen.
• 12:22
  SPEAKER_00: These are elaborate tattoos.
• 12:23
  SPEAKER_00: Yes.
• 12:24
  SPEAKER_01: So they take them to professionals to get them done.
• 12:27
  SPEAKER_00: Possibly, or maybe in maybe they have you know an in-house person who's tied to the whole scheme.
• 12:33
  SPEAKER_00: To the whole organization.
• 12:34
  SPEAKER_00: But to the whole organization, whether it be organized crime or um other facilities, you know, it could, you know, there could be so many ways that this can happen.
• 12:42
  SPEAKER_00: But if the tattoo parlors are aware, anybody that does the tattoo removals are aware, we do full-body skin exams, we check our patients everywhere, you can see these signs.
• 12:52
  SPEAKER_00: Sometimes it could be a little shotgun behind the ear, and you think nothing of it.
• 12:57
  SPEAKER_00: Ask the patient.
• 12:58
  SPEAKER_00: A patient who is being trafficked will never be upset if you asked.
• 13:02
  SPEAKER_00: And a patient who isn't, and I've done this myself because I've seen crown tattoos, and they're like, no, no, that's just me and my husband.
• 13:09
  SPEAKER_00: Um, it says his and hers, or I'm his, or um, and they say to me, Thank you for asking.
• 13:14
  SPEAKER_00: I'm safe, I'm okay, but I'm glad you asked.
• 13:18
  SPEAKER_00: Uh, they're never gonna be mad at you because you're looking out for them, and when they realize it in that context, they they say, Wow, you know, and then you end up opening the dialogue with them.
• 13:30
  SPEAKER_01: Hi, it's Patty.
• 13:31
  SPEAKER_01: I hope you're enjoying this episode.
• 13:33
  SPEAKER_01: And this is just a reminder that the Science of Skin Summit will be held in Austin, Texas, September 5th through the 7th.
• 13:41
  SPEAKER_01: Go to our website, scienceofskinsummit.com, and the registration is open and the agenda is there.
• 13:49
  SPEAKER_01: We'd love to see you there.
• 13:56
  SPEAKER_01: I would think today, especially with social media and the internet, it's just, I mean, it's petrifying, quite frankly, because it's just young people have so much access to strangers, which you know, it when we were growing up, it just wasn't that way.
• 14:12
  SPEAKER_01: But now, I mean, it just it petrifies me, honestly, especially social media, because I know there's lots of predators out there, and we've all heard these stories of especially young women getting involved with people who just do not have good intentions.
• 14:27
  SPEAKER_01: What um from a dermatologist standpoint, so you mentioned tattooing.
• 14:32
  SPEAKER_01: Are there other signs or things that we might want to be aware of?
• 14:36
  SPEAKER_01: I would think STDs and as dermatologists, we're certainly on the forefront of that.
• 14:42
  SPEAKER_00: Absolutely.
• 14:43
  SPEAKER_00: I mean, there's basic things, right?
• 14:44
  SPEAKER_00: You can be malnourished looking, right?
• 14:47
  SPEAKER_00: You can ask them, you or your staff in your history.
• 14:50
  SPEAKER_00: We should all be asking our patients.
• 14:52
  SPEAKER_00: We tend to think of this with our elderly patients.
• 14:54
  SPEAKER_00: Are you safe at home?
• 14:55
  SPEAKER_00: Where do you live?
• 14:57
  SPEAKER_00: You know, are you eating?
• 14:58
  SPEAKER_00: You know, what kind of work do you do?
• 15:00
  SPEAKER_00: You know, are you ever left alone?
• 15:02
  SPEAKER_00: You know, you can frame certain questions that can give you a hint.
• 15:06
  SPEAKER_00: And depending upon the answer, if the if the if the person is with their captor, then their body language might tell you because they're not answering, or they may do this and they look what they look like this.
• 15:18
  SPEAKER_00: What should I say?
• 15:19
  SPEAKER_00: Or the other person will speak for them.
• 15:20
  SPEAKER_00: Oh, they work for me, you know, I own a uh a dry cleaning business, I own a cleaning business, you know, some front, uh, you know, we we clean houses, I'm a landscaper, you know, I'm a roofer.
• 15:30
  SPEAKER_00: Um like I said, we we think of this for just young girls, but it's everybody.
• 15:34
  SPEAKER_00: And patients and people that come to our country that don't speak the language, they're from another country, they're at risk.
• 15:41
  SPEAKER_00: They if they start talking about, and I know this is a little controversial these days, but you know, in the past we used to say, if a patient starts worrying about being deported, I'm afraid if you're gonna tell me, you know, I'm telling you something that you're gonna call somebody, like all those are signs, you know, especially if you if you fill in the rest of the blanks.
• 15:58
  SPEAKER_00: These are all things that you worry about.
• 16:00
  SPEAKER_00: Um, you know, the submission behavior, drug addiction.
• 16:04
  SPEAKER_00: We see patients that are drug addicts, right?
• 16:06
  SPEAKER_00: You know, some of them admit they say, well, I vape a cigarette, I vape tobacco, I smoke a cigarette, but others will admit to other drugs or a history of drug abuse.
• 16:14
  SPEAKER_00: A 13-year-old with drug abuse with tattoos that's there with a man that's not her father, like flags should be going up.
• 16:21
  SPEAKER_01: Wow, it's pretty powerful.
• 16:23
  SPEAKER_01: I knew I knew this would be a very interesting subject because, like I said, it's something that's really not on my radar.
• 16:30
  SPEAKER_01: Um, I would think being in a port town, which is where I live, and you're also in a port town, you know, we probably would even have a higher incidence or a higher possibility of running into one of these patients in our practices.
• 16:44
  SPEAKER_01: Where they're coming in and out of you know, various areas.
• 16:48
  SPEAKER_01: We have certainly a lot of transition and people coming in and out of port towns.
• 16:53
  SPEAKER_00: Right.
• 16:53
  SPEAKER_00: Look in New Orleans, Miami, these areas where they host the Super Bowl and large events.
• 16:57
  SPEAKER_00: Yeah.
• 16:58
  SPEAKER_00: Um, it's possible it's very there's there's an uptick during that time.
• 17:01
  SPEAKER_00: Absolutely.
• 17:03
  SPEAKER_00: Tied to prostitution and sex rings, but all sorts of trafficking can happen.
• 17:07
  SPEAKER_00: Like you said, cruise ships, ports are easy access in and out.
• 17:11
  SPEAKER_00: Um, I recently saw read a story about a girl who was actually abducted on a cruise ship.
• 17:16
  SPEAKER_00: She went out and like her phone and everything was left.
• 17:19
  SPEAKER_00: This was uh maybe 10-15 years ago, a pretty famous story that I just hadn't heard of.
• 17:23
  SPEAKER_00: And they were looking for, they were looking for, they asked the cruise line, can you not let anybody off the ship when they docked?
• 17:29
  SPEAKER_00: The cruise ship said no.
• 17:30
  SPEAKER_00: And you know, you have to swipe out.
• 17:32
  SPEAKER_00: So theoretically, they should have been able to track.
• 17:34
  SPEAKER_01: Right.
• 17:34
  SPEAKER_00: Person was never found, they were, oh, she went overboard, this and that.
• 17:38
  SPEAKER_00: Years later, people started sending pictures to the parents.
• 17:41
  SPEAKER_00: This is your daughter.
• 17:41
  SPEAKER_00: We see her in a sex um factory, we see her in a strip club, an adult entertainment, and you know, they never were able to put it together and it's still an open case.
• 17:51
  SPEAKER_00: So the the cruise ship one is a huge one.
• 17:54
  SPEAKER_00: Um, Mardi Gras, big events, yeah, right.
• 17:56
  SPEAKER_00: You know, Rose Bowl Parade in California, you know, we can pick anything in any city.
• 18:01
  SPEAKER_00: Um, but these are things that happen everywhere, but especially when there's big crowds.
• 18:05
  SPEAKER_00: Um, Disney World, Disneyland, you know, amusement parks, you know, they can snatch a kid very quickly there.
• 18:11
  SPEAKER_00: So, you know, we want to be very careful as parents.
• 18:13
  SPEAKER_00: We want to be careful if we see anything nefarious happening.
• 18:17
  SPEAKER_00: But then we also sort of like, what do we do to help these patients?
• 18:20
  SPEAKER_00: What do we do when you're you're sitting in front of me?
• 18:23
  SPEAKER_00: I've identified that you maybe try to be a victim.
• 18:26
  SPEAKER_00: What do what do I do?
• 18:27
  SPEAKER_00: What would you do, Patty?
• 18:28
  SPEAKER_01: Well, I was gonna say, I mean, you know, we we're all very uh attuned to child protection, you know, to signs of child abuse, and we know that we are obligated by law to report child to child protection.
• 18:41
  SPEAKER_01: And I've had to do it twice in my career where I 100% knew I had to call.
• 18:47
  SPEAKER_01: And so I'm assuming that there is some place to notify if you have somebody you think is trafficked.
• 18:54
  SPEAKER_01: Is is it something similar where there's a number and a organization that you can go to?
• 19:00
  SPEAKER_01: So what is that?
• 19:01
  SPEAKER_00: I don't know what it is, Merrick.
• 19:03
  SPEAKER_00: So we'll when I I'll talk about that in a second, but here's the thing think of the timing.
• 19:07
  SPEAKER_00: Even if you called 911, how you keep what are you doing to keep the patient there?
• 19:11
  SPEAKER_00: Yeah, exactly.
• 19:12
  SPEAKER_00: Yeah, they're gonna be able to do that.
• 19:12
  SPEAKER_00: That patient's already in the wing by the time by the time they show up.
• 19:16
  SPEAKER_00: So right.
• 19:17
  SPEAKER_00: So one of the techniques, besides asking some good leading questions and trying to identify, sometimes if it's a young female, try to get something simple like a urine test where she can go to the bathroom and you can separate the two.
• 19:29
  SPEAKER_00: Separate her from the captor, right?
• 19:32
  SPEAKER_00: You know, ask the captor, hey, there's some extra paperwork in the front, but have things.
• 19:36
  SPEAKER_00: So I'm gonna I'm gonna flash it up.
• 19:38
  SPEAKER_00: It's part of my presentation.
• 19:39
  SPEAKER_00: I printed this out from my lecture.
• 19:41
  SPEAKER_00: I don't know if it'll be visible, but this is a sign right here.
• 19:44
  SPEAKER_00: I don't know if we can see it, that looks like when you're in college and you're looking to rent a room or rent an apartment, they have those little tabs with the tear-off sheets.
• 19:53
  SPEAKER_00: So I'm gonna read what this one says.
• 19:55
  SPEAKER_00: You know, it says, Scared to go home, need help, and we will help you.
• 20:00
  SPEAKER_00: And it has it in different languages.
• 20:01
  SPEAKER_00: And it says, tear off the sheet, give to one of our staff members discreetly, they'll know what to do.
• 20:07
  SPEAKER_00: So if some if this is in a in a restroom, if this is even in a patient room, if you know you could have in your lobby, and so and they don't run out because if the captor doesn't see this and makes you know, say, I don't want to be here, uh, you know, it's a dangerous spot for them, and they tear off a sheet and just slip it in your MA's pocket, you hand it to your check-in girl.
• 20:24
  SPEAKER_00: Now we already know there's a situation.
• 20:26
  SPEAKER_00: So if they somehow can alert you, then you have time if you did want to call 911, but 911 may not be the right choice, but you have the option to delay them to try to get more information.
• 20:37
  SPEAKER_00: You know this person's in trouble.
• 20:40
  SPEAKER_00: Sometimes you just need to make them follow up.
• 20:43
  SPEAKER_00: Hey, you know you're not going to get it done this visit, but let them know they're safe.
• 20:47
  SPEAKER_00: Write it on a prescription pad, old school.
• 20:49
  SPEAKER_00: Please follow up in two weeks.
• 20:51
  SPEAKER_00: You know, we need to see you back.
• 20:53
  SPEAKER_00: Let the captain, you know, she you need to bring her back.
• 20:55
  SPEAKER_00: So now you have a window of time to try to help them, assuming they come back.
• 20:59
  SPEAKER_00: In the emergency room, what happens is they they get dispositioned and they get sent back out, you know, they get treated, they get a shot of uh IV antibiotics, or or you know, they get referred to see somebody and they're gone.
• 21:10
  SPEAKER_00: But for us, we have a little more time with them, right?
• 21:12
  SPEAKER_00: So most of us do isotretinoin and eye pledge and have urine tests.
• 21:16
  SPEAKER_00: So that's a very simple way to separate to leave, right?
• 21:21
  SPEAKER_00: Um if it's a tattoo thing and you say, Hey, you know, I see the tattoos.
• 21:25
  SPEAKER_00: Can I do a skin check?
• 21:26
  SPEAKER_00: You know, sometimes skin cancers hide in tattoos.
• 21:29
  SPEAKER_00: You can buy time, right?
• 21:30
  SPEAKER_00: Most of us we try to rush out of the rooms, right?
• 21:32
  SPEAKER_00: You see a patient, you want to get to the next patient.
• 21:35
  SPEAKER_00: These are the patients you slow down for.
• 21:37
  SPEAKER_00: You give yourself more time, ask some more questions.
• 21:40
  SPEAKER_00: You know, I think you told me you you you don't smoke, but that was tobacco.
• 21:44
  SPEAKER_00: What about marijuana?
• 21:45
  SPEAKER_00: You know, you can ask questions that that give you information, but stall.
• 21:49
  SPEAKER_00: And you can see that the other guy's gonna start getting like this.
• 21:52
  SPEAKER_00: Start getting a little fidgety, start tapping, you start getting nervous.
• 21:56
  SPEAKER_00: He's busting out three cell phones.
• 21:58
  SPEAKER_00: You know, we gotta go.
• 21:59
  SPEAKER_00: Can we you know I have another appointment to get to?
• 22:01
  SPEAKER_00: Can we go?
• 22:02
  SPEAKER_00: You know, that's gonna be a hint.
• 22:04
  SPEAKER_00: And at that point, even if you can't do anything else, make the follow-up appointment.
• 22:08
  SPEAKER_00: Now, there's another slide.
• 22:09
  SPEAKER_00: I prank out a couple of my things here because this is from a lecture, so I gotta find it because we talk about the hotline.
• 22:16
  SPEAKER_00: So this one here is the number you can call here.
• 22:19
  SPEAKER_00: Is I don't know if it'll show.
• 22:20
  SPEAKER_00: I can see it's the National Human Trafficking Hotline.
• 22:22
  SPEAKER_00: It's 1-888-3737888, or you text B Free, which is 2337, right?
• 22:30
  SPEAKER_00: Oh, yeah.
• 22:32
  SPEAKER_00: 2337.
• 22:33
  SPEAKER_00: So that's that's the human trafficking hotline.
• 22:36
  SPEAKER_00: There'll be a little more of assistance than 911.
• 22:40
  SPEAKER_00: Now, another hotline is 988.
• 22:42
  SPEAKER_00: That's the suicide depression hotline.
• 22:45
  SPEAKER_00: Sometimes these patients are overlapping, right?
• 22:48
  SPEAKER_00: They're gonna they're gonna talk to you, they're gonna say, I feel like I want to kill myself, or maybe you're thinking about putting them on Accutane, or you're putting them on a biologic medication because they have psoriasis randomly, and you ask that question, they may say I'm suicidal or something.
• 23:01
  SPEAKER_00: So you want to get the help from them from the hotlines that are available to us.
• 23:06
  SPEAKER_00: So that's really important.
• 23:07
  SPEAKER_01: So, you know, to wrap it up, why don't you give us sort of some take-home points?
• 23:14
  SPEAKER_00: That one of the things I want you to, yeah, one of the things I want to talk about that I always like to end my talk with is the hand positioning.
• 23:22
  SPEAKER_00: And we've seen these stories on TikTok and YouTube and all social media of someone who's been kidnapped and they're in the backseat of a car, and they do the hand signal.
• 23:31
  SPEAKER_00: And if you know what the hand signal is, to call 911 to save them, to maybe to follow them at a safe distance.
• 23:37
  SPEAKER_00: So, what we always say is, and I've taught my children this, I teach patients this, I taught my staff this.
• 23:42
  SPEAKER_00: Um, obviously, we employ some you know women in their 20s and 30s, so we want them to be safe.
• 23:47
  SPEAKER_00: We don't want them to be victims either.
• 23:49
  SPEAKER_00: So if the more people we know, it's simple, it's like this you fold your thumb and then you cross.
• 23:54
  SPEAKER_00: You when I give the talk, I towards the end of the lecture, I make everybody do it like three, four times so they know how to do it.
• 24:00
  SPEAKER_00: If you see that when you're driving, you might save somebody's life, whether it be 911 or one of the hotlines.
• 24:06
  SPEAKER_00: But if you're a victim and you're pushed up against a window, you're being pulled out of a supermarket, you're being chased down, try to do the hand signal.
• 24:14
  SPEAKER_00: Someone may know what that means and be able to save you.
• 24:17
  SPEAKER_01: That's great.
• 24:18
  SPEAKER_01: This was really super interesting.
• 24:21
  SPEAKER_01: I've got to catch your lecture next time you give it.
• 24:24
  SPEAKER_01: Uh, I think this is, again, such valuable information, something we don't know near enough about.
• 24:30
  SPEAKER_01: And I really appreciate you spending the time to talk to me today.
• 24:34
  SPEAKER_01: Thanks everybody.
• 24:35
  SPEAKER_01: I hope you enjoyed this episode, and we'll see you all next time.