Omaha is a relatively young city. Raised on the banks of the Missouri river before Nebraska was inducted as a state, it positioned itself as the “gateway to the west,” and within decades of its founding, it drew the eye of the Union Pacific Railroad company looking to construct the radical new transcontinental railroad. This injected vitality into the city that allowed it to grow at an amazing rate. Prospectors and businessmen flooded into the city on their way to the California goldfields and became caught up in the youth and enthusiasm of the new city. It was around this time that the Union Stockyards were founded in 1883, and quickly became a major industry in the region. The cattle trade and meatpacking industry exploded and by 1955 Omaha had become the largest livestock market and meatpacking center in the United States. Omaha continued to grow and positioned itself as the hub that linked the east and west.
This history is important because it explains the state of the city now. Omaha has gained notoriety for a new kind of flesh market and its evolution and distribution are intricately tied to the city’s growth. In any city, the movement of large amounts of people causes the population to fluctuate, and with it comes an increase in the demand for sex workers. This fluctuating demand requires the movement and victimization of larger than average numbers of men and women being sold for sex. In pre-pandemic times, events like the college world series brought an influx of fans, and with it a wave of trafficked men and women.
Omaha is not unique in this; in fact, on a list of cities ranked by per capita cases of sex trafficking, it ranks only 60th at less than 15% of the leader, Washington D.C.1. And like most cities in the US, Omaha has only recently come around to the idea that the criminals in human trafficking are the buyers (johns) and the pimps—not the victims. Because of the adoption of this new philosophy, victim advocates and police have begun to work closely with each other, and FBI-lead taskforces have begun making the news for pioneering what has been called the “Omaha Model” of dismantling national sex trafficking rings2. Unfortunately, the city and the nation have been relatively new to this approach and a certain amount of feet dragging and growing pains have been a natural consequence.
Nowhere has this painfully slow rate of change been more detrimental than in medicine. Medicine is a naturally conservative profession and as a result, changes in policy often require a long time to take hold. In an international survey of medical students in 2014, it was shown that increased knowledge about the barriers to care experienced by female sex workers was correlated with a more positive attitude toward them3 and previous studies have shown that it is this perceived stigma by healthcare that is an important driver of a victim’s decision to seek care4. But even a significant change in the attitudes of the next generation of physicians might not be sufficient to stem the tide of this modern-day slavery. In one study, 88% of individuals reported encountering a healthcare professional during the time that they were being trafficked5, but according to the Nebraska Human Trafficking Task Force, 70% of Nebraska physicians do not screen for human trafficking and 84% believe they are not able to meet the needs of survivors6.
These data collected at the state and municipal level make Omaha a microcosm of the systemic problems that exist across the nation. While the trending #SaveOurChildren hashtag has brought the issue of human trafficking into the public consciousness once again, this movement has largely been all smoke and no fire. Armchair activism has its value, but the interventions that actually make a difference in the lives of individuals who are being trafficked are breaking the cycle of victimization—whether by identifying and providing help to those who need it (the role of healthcare) or by prosecuting the traffickers (the role of law enforcement). Healthcare workers need training in order to better identify victims of human trafficking and once recognized, they need to have the right skill set to respond appropriately. This directive should be twofold: didactic instruction on the realities of human trafficking and practical experience.
Several patients/victims whom I have interacted with have been wary of police involvement, but have often been willing to accept other avenues of help. This speaks to the necessity of having multiple avenues of assistance available at the point of contact—an approach that has proven difficult due to both time and monetary constraints. Therefore, the next important step in developing a systematic response to human trafficking is greater investment in developing and promoting a repertoire of resources that healthcare workers are able to provide including safe shelters, counseling, and material assistance. In Omaha, this mostly comes in the form of the excellent work done by hospital and community social workers, as well as a number of NGOs such as the Women’s Center for Advancement and Heartland Family Services, among several others. However, despite the good work these organizations do, they are fighting an uphill battle and significant cracks exist in the system through which many victims of trafficking are falling through. Closing these gaps will require a multifaceted approach that involves optimizing systems and personnel already in place and further work developing collaborative and comprehensive systems that are able to support these individuals in the short and long term. There is much work to be done and the barriers may seem nearly insurmountable, but as the old saying goes, “The best time to plant a tree was 20 years ago. The second best time is now.” We had better get started.
- Baldwin S, Eisenman DP, Sayles JN, Ryan G, Chuang KS. Identification of Human Trafficking Victims in Health Care Settings. Health Hum Rights. 2011 Jul 14;13(1):1-14.
- Boatright, A. (2018). Human Trafficking. Lecture presented at 2018 Webinar Series in Omaha, NE.