Not long ago, I read the book, "The Slave Next Door," by Kevin Bales and Ron Soodalter, and began to realize that sometimes things aren't so innocuous, even here in the US. I had heard about the sex trafficking of minors, garment sweatshops in LA and tomato growers in Florida, but never thought that a slave might be sitting in front of me. I now have gained awareness of this situation, but still don't know how to approach such a patient.
Image not availableClearly, one can't ask in front of the employers. One must make up a pretext for privacy and have a hospital employed interpreter if necessary. The employer supplied interpreter may be yet another guard. The reason for privacy could be the need to do a pelvic (for appropriate specialties) or rectal examination. Then, I have sometimes asked, as I do when I suspect a battered wife, "Are you safe? Are you OK? Anything you want to tell me? Anything else you want me to help you with?" but have not yet gotten a response of someone asking for help in such a situation. (I have had battered women and teens tell me they need help.)
Yet, I know that one must be aware of a pathology before one can identify it, whether it is a disease of the body or of the culture. I can see my awareness growing, in that I now suspect it, even when simply reading the medical records where it is stated that "two employers and the employer's interpreter" came with the patient. It also gives me the greatest reason to need a hospital or clinic employed interpreter, or phone service.
It is necessary for physicians to become aware of the problem so that there is a chance of recognizing and addressing it.