This essay will include my reflections on my experiences from medics against trafficking including my thoughts and feelings about each lecture, books and websites I have read and films watched during my self-directed learning, reflections from group work carried out and reflections on how what I have learnt and experienced in this module will impact my practice as a future doctor.
When selecting my student selected component for this semester I put this module as my first choice. I put this module as my first choice because I completed women’s global heath SSC in September where I gained some knowledge about trafficking and how this is becoming an issue in the UK which interested me at the time, so when I seen this module I felt I wanted to study it as I had an interest in the subject. I feel that trafficking is an issue in the UK, as a result I feel for my future practice as a doctor this module would help me to identify patients who could be trafficked and what to do if I suspect trafficking. Also I felt this module would be useful as there is no other modules that I do as a medical student where information about human trafficking is taught and so this was an opportunity to learn about an area that I wouldn’t learn about in any other area of the course. When I found out that I had been allocated medics against trafficking I was pleased as it had been my first choice. I felt excited about what I was going learning over the next 3 weeks especially regarding trafficking in UK and what the PSNI are doing to prevent trafficking. After reading the study guide initially I felt a bit nervous about the group work sometimes people do not always pull their weight in group projects and I may end up doing more than my fair share of the work.
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Before taking this module I thought that human trafficking was forcing people to move away from their home with the promise of a better life but when the person got to the new country or place they were forced into sex work and were not paid for it, however after completing this module I now realise that trafficking is not just forced sex but can also include forced criminality, domestic servitude, forced marriage, forced organ removal and even forced labour (1–3). In the module study guide a link was provided to a website that calculated how many slaves work for you based on the information provided, after providing my information the website calculated that I had 65 slaves, I felt extremely shocked and this made me realise that I had never considered where my clothes or shoes or electronics etc that I own came from and I had never considered that someone who made these things could be trapped in slavery (4), after completing this I feel that I will think more carefully about where my clothes, food and electronics come from and how many people have potentially been subject to forced labour for me to have these things and I feel it will make me think twice in future when I am buying those items.
Our first session involved an introduction to human trafficking I found this session very interesting before this session I thought to be trafficked a person had to be forced to leave their own country and moved to another where in fact it is actually just being forced from one area to another not necessarily crossing a country border (5,6). I also found this session extremely enlightening about the problem of human trafficking in Northern Ireland, in 2016/17 there were 34 victims, in 2017/18 there were 36 victims of trafficking in Northern Ireland and in 2018/19 there were 59 victims of human trafficking in Northern Ireland (7–10), I felt shocked as I didn’t expect there to be so many cases in Northern Ireland, and those were just the cases that were reported there potentially could be many more cases unreported or undetected. The 2019 UK annual report on modern slavery (8) shows that the majority of people who are victims of human trafficking in UK are exploited for labour (8), I felt surprised as previously I thought that most people were trafficked for sexual exploitation, this made me realise that many people could be trafficked and forced into labour in Northern Ireland and it may not seem that obvious as they are working on farms etc, after this I felt that I needed to be more vigilant for forced labour in Northern Ireland.
In our second session Women’s Aid came to speak to us to tell us about their role in human trafficking in Northern Ireland, before this session I didn’t know what to expect because I didn’t know what women’s aid did. I felt the session was extremely useful and I learnt that women’s aid are a charity that help women who are survivors of domestic abuse or human trafficking by giving them emotional support and helping them get their lives back on track (11). I feel that this session was extremely useful as I feel that when I am a doctor I will be able to use this information in my practice and I will be able to signpost women to women’s aid if I ever suspect a women is a victim of human trafficking. There was also a talk from migrant’s aid, again before this I wasn’t sure what to expect as I didn’t know what they did. I felt this talk was extremely useful and I now know that migrants aid help support adults and children who have been victim of human trafficking by providing accommodation, healthcare and financial assistance (12). After both of these talks, I now feel that should I come across a victim of human trafficking in my practice as a doctor I will know that I can refer them to women’s aid for women or migrant help for males, and they will receive the help they need.
Doctor Linda Agnew gave a talk on working with traumatised patients, she talked about how doctors can experience problems after hearing a patients trauma and where doctors can go for help if it is needed, I felt this was useful as should I experience anything like this I now know where to go for help. I also feel that is it useful for her to let us know its ok for doctors to not be ok and we need to look after our own mental health as well as patients, when I am a doctor I will ensure I look after my own mental health by making time for activities I enjoy and spending time with family and friends outside of work. During the session doctor Agnew talked about the complex nature of trauma faced by victims of trafficking and how it takes time to try to help the person process the trauma and move on, I felt this was useful for my future practice as a doctor as if I come into contact with a person who has been a victim of trafficking I now have a better understanding of this type of trauma and how to begin to deal with it.
International justice mission (IJM) gave a talk during the module, before this talk, I had no knowledge of IJM so I felt keen to know what they did. IJM explained to that they are a global organisation that works with local justice systems to try to end trafficking and help victims of trafficking (13). IJM gave information about bonded labour in India, I knew nothing about this previously and I found this very interesting to hear about. Bonded labour is a type of forced labour, the person is forced to work to repay a debt of some kind (14–16). IJM carried out a study along with Rural development and panchayat raj in India in 3 districts and found that 33% of labourers surveyed where bonded labourers and 64% of these bonded labourers were illiterate and didn’t understand their labour contract (13,14,16,17). After this I felt that such a high level of illiteracy makes these people vulnerable to being forced into bonded labour. I feel that if the government could try to increase literacy rates the number of people in bonded labour would decrease as they would understand their labour contracts and also have a chance at better jobs. IJM also talked about their work in Ghana where children as young as 3 are forced to work on lake Volta to catch fish, I found this extremely shocking as this was considered normal in their culture but this would not be considered normal in UK (13,14).
Love 146 gave a talk during the module about their work. Before this I had never heard of them and so I felt excited to learn about their work in human trafficking. I learnt that this organisation works with children and young adults who have been the victim of human trafficking, they provide support and accommodation, the organisation also acts to raise awareness of the global problem of human trafficking and try’s to educate the public on signs to look out for in trafficking victims (18). I feel this was very useful to me as a future doctor as I know the signs to look out for in potential victims (18).
Flourish NI gave a talk during the module, before this I felt interested to know what this organisation was doing as they are a local organisation and I was keen to find out what was happening in the local area. I learnt that Flourish support victims of human trafficking via their trained caseworkers and help victims to rebuild their lives (19). Flourish have six key areas that they try to help survivors build on and these include their independence, well-being, professional life, finances, community and looking to the future (19). Flourish also explained problems that survivors may face and I felt this was extremely useful because if I understand what problems may be faced I can in my future role as a doctor try to help any victims I come into contact with face these problems and reassure them that they aren’t the only person who has experienced these problems (19).
In 2015 the ‘Human Trafficking and Exploitation Act” came into force in Northern Ireland (8,10,20), this introduced the offence of human trafficking (8,20), twith the aim to target human trafficking in Northern Ireland (8,20). This act also resulted in PSNI forming “The modern slavery human trafficking unit” dedicated to targeting traffickers and preventing trafficking (20). If the PSNI receive reports of human trafficking they removing the victim to a safe place, take statements, they will ask the victim for consent to refer them to National Modern Slavery Human Trafficking Unit (MSHTU) and if consent is given the PSNI will refer victims via the national referral mechanism and finally open a criminal investigation (8,20). I felt this was useful because in my practice as a doctor if a victim approaches me for help, I can explain what the PSNI will do once it is reported to them. The PSNI has introduced training for all officers on human trafficking to help educate all officers on the signs of human trafficking (8). The officer also told about how the PSNI have a reactive and a proactive team and the proactive team follow up on tip offs to try to help those who are too scared to come forward for help and the officer discussed issues faced by the police when meeting these victims such as lack of trust. I feel that it was very beneficial having the PSNI coming to talk to us as it helped me to understand all the processes that a victim has to go through and also if a victim wants the process explained I now feel that I could do this. I also feel after this talk, I have an appreciation of how difficult the PSNIs job is to get convictions as often victims are too scared or traumatised to prosecute traffickers.
Throughout the course of the module I watched a number of videos related to human trafficking, one was made by the “No more traffick” movement and included information about spotting the signs of human trafficking (21,22). Signs that indicate a person may be a victim of human trafficking include having no form of identification, they don’t know their own address and fear authority (21–24). I feel this video helped me to learn and to recognise signs that should lead me to suspect a person is being trafficked, I feel this will improve and change my practice as a doctor in the future as I will be aware of the signs of trafficking and if I see them I can act to try to help that person. During class we also watched a film called “Not my Life” I found this eye opening to all the different areas around the world and I feel it has made me consider more where I get my food and clothes etc and to consider if slavery is involved (25).
As part of the module there was a group work assignment that involved picking a country and presenting information about human trafficking in that country and how it was being tackled. Before the group work, I felt nervous in case not everyone in the group pulled their weight, but I needn’t have worried as I found the group work very enjoyable and everyone shared the work fairly. The group choose Romania. I felt interested to find out more about the problem in Romania, as many Romanians are trafficked to UK and particularly Northern Ireland so I felt interested to learn about a local issue (26). Overall, I felt the group work was enjoyable and I feel it helped further improve my teamwork skills as I worked with my team to divide up work equally and to bring all our information together and present it.
During this module I read several books including “sex trafficking: inside the business of modern slavery” by Siddharth Kara (27), I found this book eye opening; the book states that there are 28.4 million slaves worldwide (24,27) I felt shocked as I thought in this modern age there were very few of any people who were slaves. This book also opened my eyes to how profitable human trafficking is, in particular sex trafficking, as a person who is trafficked for sex can be sold many times with some women being sold for sex up to 15 times a day, the book states that sex traffickers make around $600 million profit each year (24,27), I felt the idea of being forced to have sex many times a day horrifying and I can’t begin to imagine how terrified and traumatised those women are. The book suggests several reasons why sex trafficking worldwide is increasing these included underfunding for charities and organisations trying to combat the issue, often countries have no or very poorly enforced laws against sex trafficking and often coordinating an international response can be very difficult (24,27–29), this helped me to understand the huge issues that must be overcome before sex trafficking can be stopped, huge changes in laws against sex trafficking are needed and I felt this was going to be extremely challenging and could take a long time meanwhile these people who are trafficked continue to suffer which I feel is extremely sad and unfair to these people. The book also has a chapter on Italy, Italy has a high issue with people being trafficked to the country for sex which I felt was shocking and something I was completely unaware of, a huge problem is villa brothels that can have up to 26 women who are forced to have sex many times a day (24,27), I felt this was appalling as Italy is one of my favourite countries to visit and I never expected that it was a country that has such a problem with sex trafficking.
During the module I also read “not for sale: the return of the global slave trade and how we can fight it” by David Batstone (30), the book starts off by telling how the author who lives in San Francisco discovered that at an Indian restaurant where he went regularly there were women who had been trafficked for labour which he was unaware of for years until one of the women unfortunately died (23,30), this made me feel shocked and made me realise that for all I know a local restaurant that I go to could have the same situation and that trafficking is not always obvious and can occur without you ever realising which I feel is very sad and shocking as I like to think I would recognise it but these situations can seem so normal and everyday life and chances are I may not recognise it. The book also discusses how in the united states alone 120,000 people are enslaved and each year 17,000 people are trafficked into the country (30–32), these statistics are shocking and made me feel appalled as this is not something I expected in the United States of America, I thought in a country such as this human rights would have been extremely important and the authorities would be on top of trafficking. The author of the book discusses how he believes the global problem of slavery can be ended; the author thinks this can be done by every individual making a contribution to try to stop this (30). The author believes that even by just asking if someone is ok if you believe they could be trafficked is enough to make a difference (30). I believe that the author of the book is correct in saying that to try to end global slavery everyone needs to make a contribution (30) and I feel that even just asking someone if they are ok can make a difference as maybe no one has ever asked that person if they are ok and that small act may be all it takes for that person to open up and ask for help. This book also helped me to realise how important the role of the health care professional is in human trafficking and how much of a difference health care professionals can make to a victim of trafficking and to the global problem of trafficking. I feel that after reading this book I am more equipped to know what to look out for with respect to potential victims of human trafficking and I feel that this has changed how I look at people in my daily life and it will change how I look at patients and their behaviour and what it might mean in my practice as a doctor.
In conclusion I feel this module was very useful to my future practice as a doctor as I now feel that I would be able to recognize signs that may lead me to suspect a person was a potential victim of human trafficking. I also feel that should I come into contact with a victim of human trafficking I am aware of who to contact and where to sign post that person to get the appropriate help and information. In future I would like to keep up to date with the human trafficking picture in northern Ireland and so I will regularly check PSNI and government websites for updates on who’s affected by trafficking in northern Ireland and who is most at risk so I can watch for victims in my day to day practice.
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