A young woman
has decided to make a break for freedom. She waits until it is late at night
and crosses the border between North Korea and China. She can hear gun shots as
she frantically runs across the ice covering the Yalu River. The woman is so
scared she does not even notice the pain in her feet. Her feet are bare as she
runs through the snow and ice. Once she finally reaches safety as she meets a
member of the Underground Railroad, she realizes the condition on her feet. Her
feet are frostbitten so severely it is likely they will need to be amputated.
This woman is only one of the thousands of women who have risked their lives to
reach freedom. Even though her medical condition was serious, she is still very
fortunate to be in safe hands upon her arrival in China. Many North Korean
women who escape to China are sold as sex slaves to Chinese farmers. These
women represent the challenges victims of human trafficking experience every
day. There are victims of sexual slavery in the United States who experience
similar challenges. Although it may be a surprise to many Americans, the United
States has an estimated 100,000 children who are part of the sex trade industry
(Polaris Project, 2014). One of the first steps in decreasing the number of
victims involved in sex trafficking is to raise awareness. It is imperative for
health professionals to be able to recognize the signs of sexual slavery. These
victims are often silenced out of fear. As a future nurse, I know I will come
across patients who have been victims of sexual slavery. Currently there is no
routine training for health professionals on how to best care for these
victims. Health professionals can learn how to better empathize and care for
victims of sexual slavery by learning about the hardships experienced by North
Korean women. In this paper, I will explore the relationship between challenges
faced by victims of sexual slavery in North Korea and the United States and how
health professionals can learn from this information. This information can be
used to improve awareness and the care of victims of sexual slavery in clinical
practice.
There are
millions of people, women in particular, who are victims of human trafficking
every day. Human trafficking is defined as “the use of force, fraud, or
coercion to lure people away from home and make them work as prostitutes,
domestic servants, factory workers or other types of laborers” (Clay, 2011).
This is not only a problem in less developed countries, but a serious problem
in the United States. The Department of State estimates 14,500 to 17,500
individuals are trafficked into the United States each year (Clay, 2011). This
is only a growing problem that is the second largest illegal industry in the
world (Clay, 2011). Nancy Sidun, a supervising clinical psychologist for the
Hawaiian region, describes human trafficking as a “silent epidemic” (2011).
Some scenarios that may be red flags include a neighbor who has a wife that is
never allowed to leave the house or a coworker that hates her job but is not
allowed to quit. Traffickers often inflict forced isolation, verbal and
physical abuse, nonstop work, and fail to meet basic needs for their victims
(Clay, 2011). Even though human trafficking is a major problem throughout the
world, including the United States, it still lies as one of the most invisible
worldwide crimes. Many women become victims of sexual slavery because they are
refugees fleeing a situation in their home country. The women fleeing North
Korea become easy targets for human traffickers due to their desperation for
freedom and a better life.
North Korean
citizens suffer from food shortages, torture, inhumane treatment, and
violations of human rights every day. It is estimated that 2.8 million North
Koreans are malnourished with a lack of vital protein and fat in their diet
(Human Rights Watch, 2012). This is most likely a low estimate because it is difficult
for outsiders to get accurate data due to Kim-Jong II’s strict privacy
guidelines. Large amounts of food in North Korea are strictly kept for military
or government officials (Human Rights Watch, 2012). Citizens are tortured and
subjected to inhumane treatment due to criminal or political charges. Some of
these charges were brought about due to false confessions or bribes. Common
forms of torture include iron rods or sticks, kicking, slapping, sitting or
standing for long periods of time, sleep deprivation, and starvation (Human
Rights Watch, 2012). Women are often raped by guards as a form of punishment. Citizens can be subjected to public executions
due to petty crimes like stealing metal wire, fraud, smuggling, or speaking
against the government. There are about 200,000 people kept in prison camps.
Committing a criminal act or being related to someone who committed a crime are
common reasons for imprisonment. Many prisoners are born into these camps
(Human Rights Watch, 2012). It is illegal for North Koreans to leave the
country without permission. There is a “shoot-on-sight” order to kill any
refugees trying to cross the border without permission. There are high levels
of security for all of the borders surrounding North Korea. The highest
security is surrounding the borders of Russia and South Korea. Refugees have a
better chance of escaping to China rather than the other surrounding countries
(Human Rights Watch, 2012). Those who are caught trying to leave are either
publically executed or face a lengthy sentence of torture and imprisonment.
Most citizens in North Korea live a life full of famine, imprisonment, torture,
and violations of human rights.
Women are forced
to decide between an inhumane life in North Korea or risking their lives to
escape to China. It is estimated that two thirds of refugees fleeing from North
Korea to China are women (Young, 2011). About 80% of women fleeing North Korea
are sold as brides to Chinese farmers (Young, 2011). These women must choose
between imprisonment in North Korea and sexual slavery in China. Women are
forced into marriages, commercial sex exploitation, or into harsh labor
conditions. North Korean women who enter China live in constant fear of arrest
and deportation. China maintains strict deportation guidelines for any North
Korea caught residing illegally (Young, 2011). Refugees constantly fear being
turned in or random house raids. Children born to North Korean mothers and
Chinese fathers are not able to obtain legal citizenship in China. In the case
that a mother is deported, children are left to live with the father or other
family members. Many fathers are unfit to care for the children due to
disabilities or other mental illnesses. Sometimes children are left under the
care of grandparents who do not have the time, energy, or financial resources
to provide adequate care. “Once in China, fear of being sent back to North
Korea grips them, keeping them silent and obedient no matter how abusively they
are treated” (Young, 2011). Women are often raped by their husbands and
silenced due to the fear of deportation. One North Korean refugee who now
resides in South Korea explained her arrival in China as “shame, fear and
humiliation. I even missed my home in North Korea. Although I was starving at
home, I was at least a citizen. In China, I had to be invisible and dumb”
(Young, 2011). North Korean women who are caught in China face brutal
punishments. Refugees may face internment, death, forced abortion, or separation
from older children (Young, 2011). Women are forced to choose between sexual
slavery in China, and starvation and punishment in North Korea.
Women who escape
North Korea must carefully weigh the benefits and consequences of escaping. If
the women are caught trying to escape, they will either be killed or sent to a
prison camp. The conditions in the prison camp are so strict and oppressive
that some women may choose sexual slavery over living in the prison. In the
prison, women and men are not allowed to live together. Children are only
permitted to live with their mothers until they finish primary school. Once
children finish primary school they are taken away (Yeo-sang, 2012). Marriage
in the prison camps is not considered a human right, but a means to producing a
young labor force. “Prisoners usually prefer having many children… because many
children are killed by accidents in the mine” (Yeo-sang, 2012). There are some
camps that do not allow marriage or sexual intimacy under any circumstances. If
a woman is found to be pregnant, the guards will force an abortion and punish
the father. The infant mortality rate in the prisons is very high because there
is no maternity or child-care support. There are either no or very limited
medical services available to the prisoners. If treatments are available,
services are very simple such as medications for diarrhea or a cast for a
broken bone. Medical staff receive very little education and may include
prisoners or officers. The mortality rate from contagious diseases is very high
in the prisons due to limited preventive and isolation treatment. Even if a
North Korean is not held directly in a prison camp, life outside of the prison
camps is not much better.
North Korean
refugees have very little power and resources and require the help of outside
organizations. North Korean refugees and their children lack basic resources
like food, shelter, medical care, and hygiene materials. Many children are
orphaned and abandoned after their mothers have been discovered and deported.
An organization calling Helping Hands Korea works to deliver food and other
basic necessities to refugees and orphaned children (Peters, 2013). The
organization was founded by Tim Peters, a Christian activist. HHK’s mission
statement is to alleviate “physical, social, political and spiritual needs
through partnership with like-minded individuals, in response to Jesus Christ’s
call to love, serve, relieve suffering and set the exploited free” (Peters,
2013). HHK operates an “underground railroad” to try to help refugees escape
China and enter South Korea. Once refugees enter South Korea, they are given
citizenship and some governmental aid (Peters, 2013). There are millions of
refugees all over the world who need assistance. Organizations like Helping
Hands Korea are making a significant impact on thousands of lives. Unfortunately,
there are not enough of these organizations to assist all victims of sexual
slavery. These victims need the help of every day citizens and health
professionals. These victims have experienced traumatizing events that will
require special treatment. Citizens who are aware of human trafficking can help
identify victims by recognizing the signs and symptoms and also providing
resources for those in need. Health professionals can learn about the
experiences of victims, like the stories of the North Korean women, and use
that information to provide the most effective care. These victims will not
receive effective treatment if health professionals are not properly educated about
this issue.
Citizens and
health professionals need to understand this is not only an issue in the United
States, but also a crime that frequently occurs here in Minnesota. According to
a recent segment on Kare 11 News, the FBI considers Minneapolis and St. Paul as
two of the top cities for child prostitution (Olstad, 2014). It is estimated
that 200 girls are sold each month in Minnesota. Commander John Bandemer of the
St. Paul Police department is working with undercover officials to end sex
trafficking in the Twin Cities. Officer Bandemer explained there are websites
that feature young girls in Minnesota that are available for prostitution and
escort services. After a new listing is posted, it takes under 90 seconds for
the phone to ring with a male trying to purchase these services (Olstad, 2014).
It is estimated that one third of runaway children are sexually exploited in Minnesota
(Olstad, 2014). The prevalence of sexual slavery in the Twin Cities is
alarming. Based on these estimates, many of us come in contact with victims of
sexual slavery every day. The new Safe Harbor Law is one step forward in
providing support for victims. This law treats underage girls involved in
sexual slavery as victims rather than criminals. Even though this is a step
forward, this law only protects underage victims. Unfortunately, victims that
are of legal age are still often prosecuted as illegal prostitutes rather than
victims of sex crimes. Noelle Volin, a representative for Breaking Free, an
organization that aims to help victims of human trafficking, estimates that 85%
of adult victims of human trafficking started when they are underage (Olstad,
2014). Many victims of legal age are afraid to come forward and seek help
because they fear being charged with prostitution. There is still a lot of legal
work that needs to be done to provide psychological and physical support for
the victims of sexual slavery.
Victims of
sexual slavery suffer from psychological and physical wounds that require a comprehensive
treatment approach. There is little known about the most effective treatment
approach because this remains an “invisible” issue. Many victims suffer from
sexually transmitted diseases, pelvic inflammatory disease, hepatitis, and
tuberculosis (Black, 2008). Some of these conditions can be life threatening
and can cause permanent damage. Many of the victims face unwanted pregnancies,
forced abortions, or complications from illegal abortions. Victims of sexual
slavery suffer from high rates of nightmares, insomnia, and suicidal tendencies
(Black, 2008). There is very little research about the psychological
implications of sexual slavery. Most articles explain the prevalence of sexual
slavery and how traffickers get their victims. This is important information,
but it is not helpful when health professionals come across a victim of sexual
slavery and must design a treatment plan. Even though sexual slavery does have
a high prevalence rate in the United States, health professionals do not
receive training or information specifically about caring for sexual slaves. As
a nursing student, there is not a single piece of information about sexual
slavery or human trafficking in any of my textbooks. Nancy Sidun explains that
there has been an emphasis on prosecuting perpetrators and tending to victims
medical needs, but very little is done to address victims’ psychological needs;
“psychology as a discipline is behind the times in acknowledging trafficking” (Clay,
2011). This shows that health professionals are not receiving the necessary education
and resources to care for victims of sexual slavery. These victims need
psychological counselling, medical treatment, job training, employment,
housing, and government resources. All of these needs cannot be addressed by a
single health professional. Teams of psychologists, physicians, nurses, and
social workers are needed to address all of the needs of these victims.
Health
professionals should be aware of the common signs of sexual slavery in order to
identify victims in need. There is a long list of red flags suggesting someone
may be a victim of sexual slavery. Many of these signs can easily be
overlooked. Victims are often under tight constraints and are not free to come
and go as he/she wishes. Victims may work long or unusual hours for very little
money (Polaris Project, 2014). Victims often exhibit poor mental health or
abnormal behavior like avoiding eye contact, appearing fearful, anxious,
depressed, submissive, tense or paranoid. They may also be very fearful or
anxious around law enforcement. Poor physical health can also be an indication
(Polaris Project, 2014). Women may appear malnourished or show signs of
physical or sexual abuse. Victims often have very few or no personal
possessions. Someone else usually has control over their money, financial
records, and identification documents (Polaris Project, 2014). Health
professionals should also look for an inability to provide a permanent address.
Victims may claim they are visiting someone or may appear homeless. Even though
all of these signs may appear as “red flags”, these signs can easily be
mistaken for other conditions. A victim may be misdiagnosed with a mental
illness, homelessness, domestic violence, partner abuse, or imbalanced
nutrition. All of these conditions may be true, but if health professionals do
not identify the root of the problem (sexual slavery), the victim will not
receive all of the necessary help. Health professionals need to specifically
assess for signs of sexual slavery.
It is vital for
all members of the healthcare team to receive education and training on how to
assess and provide resources for victims of sexual slavery. The Polaris Project
is a non-profit, non-governmental program that works exclusively on the issue
of human trafficking (2014). This organization provides resources for
professionals working with victims of human trafficking in every state. The
Polaris Project has also established the National Human Trafficking Resource
Center that includes a toll-free hotline available to answer calls and texts
24/7. As health professionals begin to use resources to help victims, it is
important for them to understand the legal process of dealing with victims.
Victims may be afraid to come forward due to fear of deportation or punishment.
Health professionals must have some basic knowledge about the legal process in
order to educate their patients and provide the necessary resources. The
Trafficking Victims of Protection Reauthorization Act of 2013 combined with the
Trafficking Victims Protection Act of 2000 established human trafficking as a
federal crime with severe penalties (Polaris Project, 2013). These laws also
put into place emergency response provisions within the State Department to
respond to crises and decrease the prevalence of sex trafficking. Health
professionals should explain to victims that sex trafficking is not a criminal
act. Victims will not be prosecuted. It is important for health professionals
to build rapport and trust with their patients. It can be very difficult for
victims to confide in a stranger. Health professionals should also recommend
that their agency or organization receive training on how to identify and treat
victims. A speaker or trainer can be provided by the National Human Trafficking
Resource Center (Polaris Project, 2014). By contacting an agency that
specializes in human trafficking, health professionals can be sure they are
receiving effective and reliable information. Trainers and speakers will then
provide the health professionals with materials to review, outside resources
for victims, and methods to identify victims. Polaris Project also offers an
online interactive training program for health professionals. This could be a
great training tool that could be incorporated into new employee orientation. Some
agencies or health care organizations may not see this training as necessary. Health
professionals need to explain to their employers the prevalence and importance
of this issue on a local level. It is up to us as health professionals to be
advocates for our patients and learn how to support our patients in the most
effective way. There are many resources available for health professionals that
can be used without training.
Assessment tools
can be used to identify patients who may be victims of sexual slavery. These
tools can be used in almost any clinical setting. Before using this tool, health
professionals need to evaluate the patient’s safety. These questions must be
asked in a private environment where the patient is free and safe to talk.
Health professionals may need to ask family members or friends to leave the
room in order to provide a safe environment. It is not only important to
identify victims of sexual slavery, but to make sure there is something that
can be done to keep the client safe after the information has been revealed.
For example, a client may have children at home with the trafficker. Health
professionals are obligated to report situations of abuse. It is important to
make sure the client and children are in a safe place before you report that
information. This can be a difficult situation that may take many other
professionals (social worker, law enforcement). During the assessment, health
professionals should convey active and empathetic listening. This includes
sitting down and facing the client. Providers should avoid taking notes (or
very limited notes) while conducting the assessment. Taking notes while a
client is speaking can increase the client’s anxiety level. If the client does
not speak English or understands another language better, it is essential to
use a medical interpreter to gather the most accurate assessment data (Polaris
Project, 2014). The Polaris Project website has a very thorough assessment tool
that can be used by health professionals (2014). This assessment tool offers several
different ways to ask different questions concerning coercion, monetary
obligations, history of sexual abuse, intimate partner and inter-familial
trafficking, and details about the trafficker. After the initial assessment, there
is a “medical assessment tool” that can be used to indicate the next step. This
tool tells professionals what signs to look for, how to respond, what to do
after medical concerns are assessed/treated, and what action to take next
(Polaris Project, 2014). This assessment tool has been attached to this paper
for reference purposes. This is an assessment tool I plan to use as a future
nurse. I will also share this assessment tool with my future colleagues to
raise awareness and improve the care of victims.
As a future
health professional, I will take the information I have learned about sex
trafficking and use it to improve my practice. Nurses have the unique
opportunity to spend more time interacting with patients. This extra time
allows us to gather more physical and psychological assessment data. These
assessment tools can be used by almost any health professional in any setting.
As a hospital nurse, I may notice several of the red flag signs in one of my
female patients. This would be an opportunity for me to use the assessment tool
and further assess the situation. Nurses may also use this information in
schools or clinics. Health care providers must not overlook the possibility of
sex trafficking. If there are 200 girls who are sold into sex trafficking each
month, there is a great possibility that health professionals are coming in
contact with these women. Health professionals may not be equipped to deal with
victims. Many health care workers are not even trained to deal with victims of
rape or domestic abuse. Dealing with victims of sex trafficking is a much more
complex situation. Social workers, psychologists, law enforcement, nurses, and
physicians need to work together to address complex cases. As health
professionals, we need to act as advocates for our patients. The greatest thing
we can do for our patients is make them feel safe. Then we can help them get the
resources necessary to begin their journey to recovery. Raising awareness and
improving training programs will give health professionals the tools to be
better advocates for their patients.
The information
health professionals learn about North Korean sex slaves can be used to provide
better care and advocacy programs for victims in the United States. Health
professionals need to understand the differences between prostitution and
sexual slavery. Prostitution is an illegal crime, while sexual slavery is
slavery for the purpose of sexual exploitation. Sexual slaves can be refugees
from other parts of the world fleeing dangerous conditions in their home
country. Sexual slaves can also be vulnerable runaway children or adults. The
North Korean women were silenced due to their constant fear of punishment and
deportation. Sex slaves in the United States may also be silenced due to fear
of punishment from their traffickers or the law. Children can be born into
toxic environments of sexual slavery. Many North Korean sex slaves bore
children with their “husbands”. These children suffer from abuse, starvation,
or lack of a stable environment. Children in the United States can be born to
sex slaves in the case of unwanted pregnancies. There are many similarities between
sex slaves in North Korea and in the United States. Victims from both places
have a reason why they became vulnerable targets for human traffickers. Victims
may have run away from home due to domestic abuse, lack of resources, fear of
punishment, or may have been misled due to false promises. These victims have
also suffered from similar practices of psychological and physical abuse.
Lastly, victims from all around the world, suffer from similar feelings of fear
and silence. Health professionals should take this information and learn how to
apply it to their own patients. Raising awareness and participating in training
programs is the best way to help identify victims. Many of these victims are
silenced and need help finding their voice. It is our duty as health
professionals to be advocates and provide safety and resources for our
patients.
References
Black, J. G. (2008). Human trafficking: Common diagnoses
and the treatment of sexual exploitation. (Order
No. AAI3313086, Dissertation Abstracts International: Section B: The
Sciences and Engineering, 3260.
Clay, R. (2011). Modern-day
Slavery. Retrieved from http://www.apa.org/monitor/2011/05/slave
Human Rights Watch. (2013). North Korea. Retrieved
from http://www.hrw.org/world-report/2013/country-chapters/north-korea?page=2
Olstad, J. (2014). Kare
11 Investigates Sex Trafficking. St. Paul, Minnesota: Kare 11 News.
Retrieved from http://www.kare11.com/story/news/crime/2014/03/04/sex-trafficking-police-safe-harbor-law-investigates/5990571/
Peters, T. (2013.). Confronting the NK Crisis. Helping
Hands Korea. Retrieved from
http://www.helpinghandskorea.org/confronting-the-nk-crisis/
Polaris Project. (2014). Recognizing the Signs:
Polaris Project | Combating Human Trafficking and Modern-day Slavery.
Retrieved from
http://www.polarisproject.org/human-trafficking/recognizing-the-signs
Young, A. M. (2011.). North Korea: On Sale, Girls look for
Chinese Husbands Retrieved from
http://www.ipsnews.net/2011/07/north-korea-on-sale-girls-look-for-chinese-husbands/
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