Archive for the ‘human rights’ Category


Confronting Commercial Sexual Exploitation and Sex Trafficking of Minors in the U.S.: An IOM Report

December 2, 2013

By Natalie McClain, PhD, RN, CPNP, clinical associate professor, William F. Connell School of Nursing, Boston College, and Barbara Guthrie, PhD, RN, FAAN, Independence Foundation Professor of Nursing, Yale University School of Nursing. The above educational video was created by the Institute of Medicine and is available on YouTube.

Each day in the United States, minors experience abuse and violence that is overlooked and unidentified. In some cases, recognition of the abuse makes these minors subject to arrest rather than assistance and care. These children and adolescents are the victims and survivors of commercial sexual exploitation and sex trafficking. A recent report from the Institute of Medicine (IOM) and the National Research Council sheds light on this serious domestic problem and underscores the critical role that nurses must play in preventing, identifying, and responding to these crimes.

Confronting Commercial Sexual Exploitation and Sex Trafficking of Minors in the United States is the culmination of a two-year study conducted by an independent panel of experts appointed by the National Academies of Science and funded by the Department of Justice’s Office of Juvenile Justice and Delinquency Prevention. The report states that commercial sexual exploitation and sex trafficking of minors are acts of abuse and violence against children and adolescents. However, the response to these victims is often starkly different from that experienced by other victims of child abuse and neglect. In most states, for example, underage victims of commercial sexual exploitation and sex trafficking can be arrested and prosecuted.

Long-term consequences; inadequate services. The report also notes that the consequences of commercial sexual exploitation and sex trafficking are far-reaching and long lasting and include a range of mental and physical health problems. The committee found that there are too few services available to meet current needs of victims of commercial sexual exploitation and sex trafficking of minors. In addition, “services that do exist are unevenly distributed geographically, lack adequate resources, and vary in their ability to provide specialized care to victims/survivors of these crimes” (IOM and NRC, 2013, p. 260).

This form of abuse and violence against children and adolescents is largely underreported. This is because identification of victims can be challenging. Once victims are identified, there are few service providers who are adequately prepared to assist and care for them. The report describes this and numerous other challenges faced by professionals in law enforcement, education, victim and support services, and health care who seek to prevent and identify these crimes and to assist their victims. It also provides clear guidance on and examples of strategies to increase awareness, strengthen laws, and advance knowledge and understanding.

Nurses are essential partners in preventing, identifying, and responding to commercial sexual exploitation and sex trafficking of minors. Two of the report chapters—Health and Health Care and The Education Sector—underscore the critical role of nurses as first responders in prevention, detection, and care of victims. Victims may seek out health care, thereby providing an opportunity for nurses in a range of settings to identify victims and survivors of this abuse. Read the rest of this entry ?


Kudos to Indy for Tightening Human Trafficking Laws Before the Super Bowl

February 3, 2012

Market St., Indianapolis/ via Wikimedia Commons

According to (a news site of the nonprofit Pew Center on the States), with the Super Bowl taking place this Sunday in Indianapolis, the state of Indiana has decided to toughen up its human trafficking laws.

“Though it is an honor for Indiana to host the Super Bowl, many sincere voices have brought to light the fact that human trafficking is a shameful practice we can’t ignore,” Indiana attorney general Greg Zoeller said in a statement.

The article notes that sex trafficking during highly publicized events has become an issue for many states with hosting duties. While the Global Alliance Against Traffic in Women, an international advocacy group, claims that the estimates of trafficking cases at previous Super Bowls may have been too high, whether there are 60,000 or six in a given year, any number over zero is too many.

For more info, see our award-winning article on the nurse’s role in combating human trafficking, by Donna Sabella. She also talks about her work in a podcast.—by Demaris Bailey
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Domestic Violence Screening Matters

October 12, 2011

By Karen Roush, MS, RN, FNP-C, clinical managing editor

I am a nurse. I am a doctoral candidate and a writer. I am a domestic violence survivor. I lived for years with fear and uncertainty—will this be a good day, a day of laughter and affection? Or a brutal day of fists and humiliation? Like many women experiencing domestic violence, I hid it from my family and friends. In fact, I even hid it from myself. I couldn’t see myself as a battered woman, wouldn’t accept that I was that kind of person. But domestic violence doesn’t happen to a certain kind of woman—it happens to anyone, rich or poor, college educated or high school dropout, urban and rural, of every ethnicity. We—you and I—all are the faces of domestic violence.

Just ask. October is National Domestic Violence Awareness Month. How many of your patients have you asked about domestic violence this month? Or any month? Twenty? Ten? None? Screening matters. One of every four women you see has experienced domestic violence. Research tells us that women will talk about it when asked by a provider that they feel cares and can be trusted. They will leave an abusive situation when they feel supported and resources are available to them. Read the rest of this entry ?


‘The Worst I’ve Ever Seen’: One Persistent Nurse’s Take on Somalian Refugee Situation

September 20, 2011

By Shawn Kennedy, editor-in-chief

Long-term care: Martone at a refugee camp in Uganda back in 2001

Gerry Martone is a nurse who has traveled to the far reaches of the world in his job as director of humanitarian resources at the International Rescue Committee (IRC). We ran a profile of Gerry in 2001 and also a photo essay. He’s also a skilled photographer and we’ve published his photo essays documenting his travels. (See here for one on assessing poverty in Afghanistan and here for one on Sudan refugees; click through to PDF versions for best viewing.)

So when I spoke with Gerry last week, shortly after he came back from a visit to a refugee camp in Kenya, it scared me when he said the situation in East Africa is the worst thing he’s ever seen. The region is plagued by a severe drought (Martone says it’s had no appreciable rain in two years), and while drought is a cyclical phenomenon there,  a struggling central government, lack of health and response systems, and ongoing  conflicts among local clans have worsened the situation, causing widespread food shortages. The global community is responding with aid, but for many, it will be too late.

He visited a UN camp outside the city of Dadaab, Kenya, to which more than 440,000 displaced people—mostly Somalians, who are the hardest hit—have fled. The IRC runs a hospital at the camp. The situation is dire: the UN estimates that, without intervention, 750,000 Somalians face death within four months. And it doesn’t have to be this way—it’s a matter of making potable water and food available—though even with supplies on hand, it’s hard to get them delivered to those in need. Martone said the area is completely lawless and very dangerous—he traveled with six armed guards—and many organizations fear sending their workers.

Martone said if people want to help, they should donate to an aid agency they feel comfortable with—and there are many doing work in the region, including the IRC, Doctors Without Borders, and the UN Refugee Agency, to name a few.

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Saving ‘Mimi’: How Nurses Can Combat Human Trafficking in the USA

February 1, 2011

By Sylvia Foley, AJN senior editor

Never to lie . . . by flickrohit, via Flickr

Picture this: “Mimi,” an 18-year-old Brazilian girl who speaks little English, arrives in your ED with injuries sustained in a beating. She’s accompanied by an older man who refuses to leave her side and who intercepts and answers questions directed at Mimi. The ED physicians and nurses treat Mimi’s injuries and release her back to this man’s care. Maybe you feel uneasy, but what can you do? Maybe the man really is her uncle; maybe he’s just being overprotective.

In fact, Mimi is a victim of human trafficking, and the man who brought her to the hospital is both her pimp and her trafficker. And you and your colleagues just missed a chance to intervene on her behalf. Unfortunately, you’re not alone. In “The Role of the Nurse in Combating Human Trafficking,” a February CE feature, author Donna Sabella notes that clinicians who encounter victims of human trafficking often don’t realize it, and many such chances to intervene are lost. Sabella, a nursing professor active in helping such victims, hopes to change this. Read the rest of this entry ?


In Her Own Words: Pakistani Flood Victim Focuses on Providing Essential Medical Help to Others

September 30, 2010

Yesterday we posted here on the threats facing medical aid workers in unstable countries, with a special focus on the work of the international aid organization Merlin in Pakistan following this summer’s catastrophic flooding. Today we publish a first-person account by Azra Habib, a Lady Health Worker who has been working for Merlin’s diarrhea treatment unit (DTU) in the flood-affected Charsadda district of Khyber Pakthunkhwa. She, like many health workers, has opted not to focus on the potential risk she faces or her own family’s losses, but instead on the immediate need for basic health care services.—Jacob Molyneux, senior editor/blog editor

Azra Habib at a Merlin Diarrhea Treatment Unit in Pakistan

I’ve recently taken a new post as a Lady Health Worker for a diarrhea treatment unit (DTU) at the Charsadda District Hopital in KPK. After the floods there were many villages in the district with no clean water, and the demands on this specialized ward can be extreme. Having lost everything, many people don’t have the resources to get transport to the hospital. Often, by the time they get here, patients are moderately or severely dehydrated and need to be admitted. There are 40 beds but we’ve had as many as 189 patients arrive on the ward in a day.

A toddler recovering from dehydration brought on by acute watery diarrhea

Early one morning, not long after I started my position here, I was about to sign off from my night shift duty. A woman came in, crying out with a child not yet three years old in her arms. She was screaming, “He is not moving, he is not responding.” He had been suffering from diarrhea for two days. When the doctor saw him, he noted that his condition was grave and we started immediate treatment: an IV line to restore his fluid loss and antibiotics to treat his infection.

The boy had lost his father and 5-year-old sister in the flood. This meant that his mother had no one else left. I asked if I could take care of the child and continue my shift rather than sign out, and the doctor allowed me to do so. So I put in all my efforts to his recovery and the child started to respond in the evening. He remained in the DTU for five full days, and when he fully recovered he was discharged.

Noshad Ali holds his 2-year-old grandson, Mohammad Faizan, who is recovering from severe dehydration brought on by acute watery diarrhea

A very personal catastrophe. I wanted to make sure he survived because I know what it means to lose everything and to be left with heavy responsibilities. Prior to the floods in Pakistan, I worked for five years in my village, Banda Malahar, as a health worker. At the same time, I was close to finishing my nursing and midwifery studies. I was in the process of taking my third-year nursing exams when the floods hit and destroyed the area where I live. That day, I was on my way to the city to take exams when I saw water was fast approaching on the motorway. As the bus driver backtracked, I saw all the bee boxes from the nearby farms, floating in the water. I suddenly forgot about my exams and started to worry about my home.

I couldn’t reach my family by phone, but I’d heard on the radio that all of Khyber Pakhtunkhwa had been affected by flash floods. When I finally reached my elder brother by phone the next day, he told me that the whole village had been swept was away by water and there was nothing left. He told me that my sisters-in-law and their children found refuge in a school, while my three brothers were living in a tent on the motorway. He told me that our parents refused to leave the house. So we had no idea if they had survived. I was horrified by the news and felt very restless.

Only silence. Eight days after the flooding started, I finally found my parents. They had found shelter in a school. A week later we returned to Banda Malahar, which was washed away. There was nothing left, only silence. I was standing in ankle-high muddy water and debris. We took the household items we could salvage and what we could find to pitch up a tent to live in. Neighboring families began returning, pitching tents in the footprint of where their homes had once been.

Now everyone is developing severe skin infections, or coming down with diarrhea and malaria, which my sister has also contracted. Living conditions prior to the flood were very poor and now they’ve gone from bad to worse. The floodwaters took everything we had; even my elder brother’s beekeeping business is finished. Read the rest of this entry ?


The Grave Dangers Facing Medical Aid Workers in ‘Insecure’ Regions

September 29, 2010

I recently heard from Jacqueline Koch, a senior communications officer with the global medical aid group, Merlin. As described in a recent AJN photo-essay on Merlin’s work in Gaza (for the best view, click through to the PDF version), the organization partners with local health organizations and trains health workers to provide care in response to natural and man-made disasters. Ms. Koch has now shared with AJN a first-person account of one Pakistani woman’s experiences working with flood victims, which includes a description of that worker’s own family’s suffering as a result of the flood. This account, which will appear tomorrow along with several photos, is prefaced below by Ms. Koch, who provides context for Azra Habib’s story. The security issues raised by Ms. Koch are frightening, in that we now see an already taxing kind of health care work becoming even more perilous because of the threat of physical attacks like the murder of 10 medical aid workers in Afghanistan back in August.—Jacob Molyneux, senior editor/blog editor

A toddler recovering from dehydration brought on by acute watery diarrhea in Merlin's DTU in Charsadda.

‘Senseless but simple.’ In Pakistan, alongside a breadth of man-made and natural disasters, there are many occupational hazards and cruel ironies, especially for aid and health workers. It’s senseless but simple: delivering aid, providing medical care, and saving lives can potentially make you a target.

For any Pakistani national health worker who is working for an international nongovernmental organization (INGO), the danger multiplies. Not only can they themselves be threatened, but so can their parents, siblings, spouses, children, and extended families. They face armed attacks, death threats, robbery, kidnapping for high ransom, and the very real possibility of murder.

Many must navigate these dangers by refraining from visiting nearby family, living in close proximity of their offices, and hiring guards to escort their children to and from school. When working in the field, many opt to leave hats and jackets with INGO logos and ID cards behind, alongside their BlackBerries and anything else that might identify them. They have little choice but to dramatically alter the rhythm of their lives in order to save lives—including their own. But these measures are not always foolproof.

Not just in Pakistan. Merlin, an international medical aid organization, recently published a report outlining the impact of violence, conflict, and insecure environments on health workers, who are central to achieving the United Nations Millennium Development Goals. For those delivering essential health care in fragile or conflict-affected states, it is “A Grave New World.”

As one female health worker in Pakistan in conflict-affected Swat Valley (and who asked for anonymity) noted:

“The militants were against family planning, saying women must stay in the home. As a Lady Health Visitor, I was suspected of providing family planning and therefore at risk. During the militant regime, I could not reach women, I couldn’t meet my patients. If someone knew what my job was, they would have cut me to pieces. I often think about it, I think about my children, because my job is something my family needs. My family needs my job to survive. But I had to stop working here during the regime. I left. While I was away, I thought about my patients, I thought about those who I left behind and who didn’t have anyone to care for their health.” Read the rest of this entry ?


Are Domestic Violence and Pregnancy Preexisting Conditions?

November 6, 2009

By Peggy McDaniel, BSN, RN

Kaiser Health News recently ran a story about an attorney who was denied private insurance coverage based on a “preexisting condition”—that is, treatment she’d received following a domestic abuse incident. A majority of states have passed laws prohibiting insurers from denying coverage based on treatment for domestic violence, but  eight states as well as the District of Columbia have no such legislation. It is a challenge to track the occurrence of such denials. Insurers often use alternative ways to find out about a history of domestic abuse. They have been known to search for protective orders at local courthouses, which is public information, and search through medical records for documentation of treatment related to such incidents. 

A bitter irony is that nurses are expected to be aware of and directly question patients about suspected abuse, yet in doing so we could be setting up patients for future loss or denial of coverage. 

Pregnancy, likewise defined as a preexisting condition, can also be used to deny coverage. Health reform bills under consideration would disallow the practice of basing insurance rates on gender, a practice which has in effect discriminated against women, particularly those of child-bearing age. 

The practice of denying private health insurance coverage based on these and other preexisting conditions must stop. As a nurse and a consumer, I believe that everyone should be able to buy health care at a reasonable price. A rate such as $1,000 per month for a family is not affordable. In the end we all pay if people do not have some kind of coverage, since the uninsured do eventually receive care—from ERs, which are mandated to provide this care. 


By moggs oceanlane, via Flickr

The very idea that a person can be denied health insurance coverage for a history of domestic violence should encourage us to look closely at reform efforts under discussion and actively join in the conversation. As nurses we are asked to support our patients and promote physical and mental health.  If the very support we give, such as a referral to a domestic violence support group, causes a patient to lose her insurance, we all fail.

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Sudanese Rumors of Ebola Outbreak a ‘Cry for Help’ – Is the Obama Administration Listening?

October 23, 2009

By Shawn Kennedy, MA, RN, interim editor-in-chief

ReutersSudanReuters reported Thursday that there is no Ebola outbreak after all in the southern Sudan. Rather, the rumors were started by local administrators and representatives of the Sudan People’s Liberation Army (SPLA) “to draw attention . . . to the acute lack of medicine” in the area, according to Kuol Diem Kuol, an SPLA spokesperson.  According to Reuters, the false rumors that 20 soldiers and three of their wives had died were successful in bringing health personnel to the area to investigate . . . and to provide the desired medicines.

I can’t help thinking that conditions must be really really bad if the Sudanese people went to the lengths of staging a hoax to receive health care. After all, this is a people that has withstood some of the worst brutality in recent memory from civil wars and the genocide in the Darfur region. Read the rest of this entry ?


Nurse’s Aide Brings Nursing Home Sexual Abuse to Light—But Why Did It Take So Long?

September 22, 2009

NursingHomeAbuseScreenshotA few weeks ago I came across an article in a Virginia newspaper in which reporter Mike Owens wrote about the arrest of James Wright, who was indicted on four counts of aggravated sexual battery against different patients in a nursing home where he worked as a nurse’s aide from 2000 until 2007. The nursing facility, NHC HealthCare – Bristol, is one of 76 facilities owned by National HealthCare Corporation. According to the story, staff members—from peers to administrators—had known about Wright’s abuse of patients for years, but nothing was done to stop it until Patty Davenport, another nurse’s aide, frustrated and appalled that no action was being taken, lodged a complaint with the Office of the Attorney General of Virginia.

To me, Davenport is a hero. But why did this take so long to come to light? A more recent article by Owens reports that several staff have accused the then director of nursing, Anne Franklin, of “trashing” their written complaints about Wright.

Through her attorney, Franklin denies this. I hope it’s not true. I’d like to think that any nurse who learned of such egregious acts would immediately take action to protect patients and blow the whistle long and hard. Read the rest of this entry ?


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