Out of the Shadows
By Sean Price Texas Medicine June 2018

June 18 TM Public Health

When local crisis centers approached the Lubbock County Medical Society (LCMS) last year to help raise awareness of sex trafficking locally, Melinda Garcia Schalow, MD, said her first reaction was basically, “How big can the problem be?”

“In West Texas, I think we feel like we are isolated from sex trafficking, and that only happens in big cities like Houston, New York, or L.A.,” the veteran Lubbock surgeon said. 

She found out, however, Texas in general and Lubbock in particular have a significant problem with sex trafficking. (See “A Chance to Help,” January 2016, Texas Medicine, www.texmed.org/AChanceToHelp/

About 79,000 minors and young people are victims of sex trafficking in Texas, according to a 2016 report by The University of Texas Institute on Domestic Violence and Sexual Assault (tma.tips/Trafficking). In Lubbock, the local rape crisis center, Voice of Hope, assisted with 68 victims of sex trafficking in 2017, and 19 of them were between 8 and 18 years old. 

In addition, a 2014 study published in the Annals of Health Law (tma.tips/Annals) found 87.8 percent of survivors of sex trafficking had contact with a health care professional.

LCMS members quickly agreed there was a problem locally, and that physicians could be unknowingly overlooking ways to help. So they acted quickly, and in October established four goals to combat sex trafficking of minors: educating physicians, improving patient care, promoting prevention, and raising awareness. 

June 18 TM Public Health SchalowDr. Schalow, a project committee co-chair, now regularly gives presentations to medical students at The Texas Tech University Health Sciences Center School of Medicine in Lubbock on how to identify victims of sex trafficking in the exam room. But each time she does, she’s unsettled by the fact that she’s been educated only recently herself.

“I’ve been an orthopedic hand surgeon for 20 years, and I’ve taken care of a lot of hand fractures and forearm fractures and ruptured tendons, and I have repaired injuries from knife wounds and blunt trauma,” she said. “But I have to tell [students] I’ve never taken care of a human trafficking or sex trafficking victim. And the reason is: I didn’t ask — I didn’t recognize it.”

With help from the Texas Medical Association and area first-responders, LCMS moved to improve care for these patients by creating a set of protocols for local hospitals and clinics to follow when a health care worker identifies a sex trafficking victim. Steps include, for instance, notifying medical personnel to collect evidence and calling Child Protective Services. 

As part of this effort, Covenant Children’s Hospital is working to create a special room for young victims to stay for 72 hours while social services professionals make long-term arrangements. 

“We’re looking for a safe place for victims while all the adults work out a plan — buying them a little bit more time,” Dr. Schalow said.

To promote prevention, LCMS has worked with Voice of Hope and OneVoiceHome, a shelter under development to primarily assist girls ages 11 to 17. The county medical society produced stickers designed for mirrors in area bathrooms. The stickers provide phone numbers where sex trafficking victims can get help.

LCMS also produced a calling card (opposite page), disguised to look like that of a nail salon, to distribute to at-risk young people in hospitals, schools, and other locations. The card is meant to be a lifeline to somebody who wants to get help but is afraid.

“You can tear off the questions [on the bottom half of the card], throw them away and keep the [top part of the] card,” Dr. Schalow said. “And if you ever find yourself in a bind, you can call one of these numbers. That way the trafficker never knows what those numbers really are.”

In February, LCMS received a $1,320 grant from the TMA Foundation, the association’s philanthropic arm, to raise awareness of sex trafficking. Even before the award, medical society members had gone on radio shows, reached out to public school nurses, and hosted a forum on sex trafficking with the local Junior League. The efforts also prompted Lubbock’s mayor to issue a proclamation on sex trafficking in January, an event covered by local media. 

All this physician involvement has dramatically raised local awareness of sex trafficking, said Laura Pratt, executive director at OneVoiceHome. 

“Whether [physicians are] aware of it, they just have a lot of status in our community,” she said. “Having them on board with recognizing victims and meeting victims’ needs has kind of implemented a lot of change and awareness. It’s been fun working with them because they are now becoming part of the solution.”

Though the LCMS effort isn’t solely about direct patient care, it clearly addresses an important health care issue, said Dr. Schalow. It’s easy for physicians to get bogged down in day-to-day concerns about paperwork and regulations, and an initiative like this, she says, is a reminder of what physicians can do when they work together. 

“It’s really nice to see the response to this issue, bridging all different businesses and organizations,” she said. “And it’s nice to be a part of it.”

More information and resources on human trafficking — including free continuing medical education (CME), an educational video on prevention, and ways to report abuse — can be found on TMA's Human Trafficking webpage.

Warning Signs

Here are some cues physicians can use to spot victims of human trafficking. You may notice a patient: 

  • Shares a scripted or inconsistent history
  • Is unwilling or hesitant to answer questions about  injury or illness
  • Is accompanied by an individual who does not let the patient speak for him/herself, refuses to let the patient have privacy, or interprets for him/her
  • Shows evidence of controlling or dominating relationships (excessive concerns about pleasing a family member, romantic partner, or employer)
  • Demonstrates fearful or nervous behavior or avoids eye contact
  • Resists assistance or demonstrates hostile behavior
  • Is unable to provide his/her address
  • Is not aware of his/her location, the current date, or time
  • Is not in possession of his/her identification documents
  • Does not control his/her own money
  • Is not being paid or wages are withheld

Go to tma.tips/TraffickingSigns for a complete list, including health indicators and how to follow up.

Source: National Human Trafficking Resource Center

Tex Med. 2018;114(6):46-47
June 2018 Texas Medicine Contents 
Texas Medicine Main Page


Last Updated On

September 04, 2019

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Sean Price


(512) 370-1392

Sean Price is a reporter for Texas Medicine and Texas Medicine Today. He grew up in Fort Worth and graduated from the University of Texas at Austin. He's worked as an award-winning writer and editor for a variety of national magazine, book, and website publishers in New York and Washington. He's also helped produce Texas-based marketing campaigns designed to promote public health. Sean lives in Austin and enjoys hiking, photography, and spending time with his wife and two sons.

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