CHI builds community's defense against sex trafficking

November 15, 2018


Polaris, a nonprofit organization assisting human trafficking victims in the U.S., estimates that they number in the hundreds of thousands. A heat map generated from calls to its National Human Trafficking Hotline shows that people are trafficked in every state in the U.S., in communities large and small.

Public events like this film screening raise community awareness to combat sex trafficking in and around Roseburg, Ore.

Polaris estimates that one out of every six "endangered runaways" reported to the National Center for Missing and Exploited Children are child sex trafficking victims. Defending children — and adults — starts with increasing awareness of the ubiquitous, but concealed threat and the way human trafficking's tentacles can ensnare victims, said Marion Kotowski, the violence prevention specialist for the Mercy Foundation in Roseburg, Ore. Kotowski is a leader in that community's efforts to address child abuse and recognize and combat human trafficking.

The Mercy Foundation is the community benefit arm of Mercy Medical Center, a member of Catholic Health Initiatives. And CHI's Mission and Ministry Fund has contributed close to $1 million over six years through its United Against Violence program to support the Mercy Foundation's efforts to address some of the root causes of child abuse in Douglas County. Kotowski said the anti-human trafficking component of that child abuse prevention work was catalyzed by the brutal sexual assault of two young teenagers several years ago.

Small town vibe
Roseburg is a town of 22,000 on Interstate 5, the state's major trucking throughway. It is the government seat for Douglas County, which sprawls some 5,100 square miles from the Pacific Ocean into the timber belt of the Cascade Range. Kotowski said that in Roseburg, sex trafficking can be hidden. Prostitutes do not walk a regular "stroll." Instead, businesses that look legitimate to the casual observer, may be fronts for the sex trade. Most people in Roseburg never have occasion to think about the victims of prostitution in their community.


The Douglas County Human Trafficking Task Force, an offshoot of the county's Up2UsNow Child Abuse Prevention Coalition, is working to change that. (See sidebar, below.) The coalition, which is funded by grant money from CHI and the federal Crime Victims Fund, coordinates with more than 30 local and state agencies, organizations and individuals to address sex trafficking and raise community awareness around the issue.

Front line in health care
Educating workers in health care fields is especially important, Kotowski said. "Up to 88 percent of victims of human trafficking come into contact with medical personnel who can easily screen for it by asking whether the patient is being forced to have sex with anyone or to work long hours without pay." She added that many sex trafficking victims don't recognize or acknowledge they are being trafficked, having been convinced by the trafficker that the money they bring in is needed for daily necessities or a better life in the future.


As system director of advocacy, Laura Krausa has helped advance CHI's anti-trafficking initiatives. She explained that people can be lured into trafficking under the guise of a romantic relationship that keeps them emotionally bonded to their abuser even after "they are used as a commodity. This is where the 'force, fraud and coercion' necessary to determine trafficking comes into play. There is also an incredible loss of autonomy and there might be shame involved. Ultimately, the reasons victims may not acknowledge they are being trafficked are complex."

Kirstin Carhart, the reproductive health coordinator at Umpqua Community Health Center in Douglas County, attended a training session for sexual assault nurse examiners given by members of the trafficking task force earlier this year. Carhart said she realized she may have missed warning signs that some of her patients had been coerced or forced into prostitution. "Realizing that made me sick to my stomach," she said.

At Carhart's invitation, Kotowski provided the training to Carhart's colleagues on the reproductive health staff at the community health center in July. Said Carhart: "I realized we were sort of asking the right questions, but the way we responded to patients needed to be adjusted.

"If you're not watching with a corrected lens, hearing patients' responses differently and recognizing the potential for trafficking, you can miss it, as it can be subtle. We need new questions to help patients look at their lives differently."

Truckers Against Trafficking says that more than 622,000 truckers have completed its training to assist law enforcement in the recognition and reporting of human trafficking in the U.S.

Recognizing the problem
Kotowski said the Douglas County Human Trafficking Task Force was organized in the aftermath of an egregious assault that was brought to her attention as a member of a team that reviews cases of alleged child abuse. "Two teens were approached by a guy who offered them an opportunity to go party, and they went with him," she recalled. "He drove them to an area they didn't know, provided them with alcohol and drugs, took their shoes and then invited his friends over to rape them."

Kotowski knew this was a sexual assault case, but thought it might be more. She spoke to a friend who works with survivors of human trafficking and determined it fit the criteria. "I knew human trafficking was a problem, but those of us at the child abuse prevention meeting didn't realize what it would look like in our community," she said. "We didn't recognize it for what it was."

Kotowski started looking for data on human trafficking in the county and learned that none was being collected. She spoke with police detectives. Some said they had seen evidence of trafficking; others said they had not. Kotowski called Krausa, who put her in touch with individuals working on human trafficking prevention in Kentucky.

"I realized we were not educated in the way we needed to be on this issue," Kotowski said. After spending six months learning how to recognize human trafficking, she called the Oregon Department of Justice in Portland to invite staff there to Roseburg to meet with and train community leaders. Then task force members spent six months learning about how to best educate the community.

Marshalling forces
"Every sector within a community and every person can play a part in recognizing the signs of human trafficking, preventing its occurrence and making a difference," said Kotowski. "Unlike in the movies and on TV, only 10 percent of human trafficking involves kidnapping," she continued. "The rest occurs through coercion, people being blackmailed or tricked or pressured into questionable activities. Family trafficking involves children traded in payment for drugs, rent or food.

"Delving into anything about the underbelly of your own community is not something people are comfortable with or want to do, but people are paying attention now, and talking about the issue," Kotowski said.

Among the agencies and organizations working together on the task force are the Department of Human Services; law enforcement at the state, county and local levels; a county narcotics team; substance abuse prevention experts; and the Battered Persons' Advocacy.

Before they hit the road, students in Umpqua Community College's truck driving certification program learn who to call when they see or hear suspicious activity that could signal sex trafficking.

Truckers fight trafficking
Early on, Kotowski reached out to leaders of the Umpqua Community College's professional truck driving certification program. "Trafficking victims often show up at truck stops, and we have three in Douglas County, so three years ago, I offered the school a session on how to recognize a victim of trafficking," she said. Now she teaches during every six-week session using a curriculum and video produced by Truckers Against Trafficking, a nonprofit group that works nationally. She asks the students to be alert to CB radio chatter advertising commercial sex at truck stops or nearby hotels and pass information on to the National Human Trafficking Hotline or local law enforcement.

Instructors in the truck driving program made sure Kotowski was invited back. "They said as they thought back on their own experiences, they realized they had missed opportunities to recognize human trafficking," she said.

Last year, the Zonta Club chapter in Roseburg, an organization of professionals who advocate for women's rights locally and globally, recognized the Human Trafficking Task Force for its work, and word about preventing trafficking continues to spread.

"I am very proud of our task force and we have a great plan moving forward. I believe that in the next year or two, many things will change about how we think about trafficking and how we screen for it," Kotowski said.

"Human trafficking crosses every single line you can think of — economic status, age, race, gender. And that's everybody."


Resources for health care providers

Catholic Health Initiatives worked with the American Hospital Association's Hospitals Against Violence Initiative and clinicians at Massachusetts General Hospital's Human Trafficking Initiative and Freedom Clinic to help develop the diagnostic codes for human trafficking that were added last month to the International Classification of Diseases 10th Revision, Clinical Modification (ICD-10-CM) used in the United States.

The new codes are intended to capture the complexity of medical and psychological issues that can be common among trafficking victims. And the codes are expected to raise awareness of human trafficking among medical professionals. Over time, they will provide data to better understand the scope of human trafficking. "This is a significant step forward," said Colleen Scanlon, senior vice president and chief advocacy officer for CHI. "Having these codes will help clinicians adequately classify a diagnosis and plan appropriate treatment. And it will demonstrate that this is a serious problem that must be stopped.''

CHI offers free access to its 25-minute web-based clinical education module on human trafficking at

CHA resources on combatting human trafficking are available at



Spreading the word about human trafficking

Founded in 2014, the Douglas County Human Trafficking Task Force spreads awareness about human trafficking in these ways:

  • Training medical providers and staff at Mercy Medical Center in Roseburg, Ore., and clinics and urgent care centers in the county.
  • Training students in the professional truck driver certificate program at Umpqua Community College to recognize sex trafficking, alert authorities and potentially save a life. (Truck stops and highway rest areas are a locus for the sex trade.)
  • Educating nursing, dental assistant and paramedic students at Umpqua Community College to recognize potential victims of human trafficking and help guide them to rescue services.
  • Training law enforcement officers, security officers and advocates to recognize signs of human trafficking and familiarize them with resources available to aid victims.
  • Holding community awareness events including screening a documentary and presenting a play to raise sex trafficking awareness.


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