NP Tara Leach met 24-year-old Amanda* two years ago when she came into The Ottawa Hospital emergency department complaining of anxiety and suicidal thoughts.

Looking to uncover the source of Amanda’s distress, Leach screened her for sexual assault and domestic violence. As a sexual assault nurse examiner (SANE) and clinical lead for the hospital’s Sexual Assault and Domestic Violence Treatment Centre, Leach is trained to recognize the signs of these kinds of traumas.

But as Amanda opened up about her life, her story didn’t quite add up to a case of isolated sexual assault or intimate partner violence. Instead, she showed telltale signs of a different form of exploitation.

Amanda had recently moved in with a man she called her boyfriend, relocating from Toronto to Ottawa, where she knew practically no one. She was about to start university when the tuition money her parents provided mysteriously disappeared from her bank account. To make matters more confusing, her boyfriend started claiming he had in fact paid her tuition, and she owed him for it. “He made her feel she had this debt (to him), and it needed to be paid,” Leach recalls.

As Leach continued to speak with Amanda, she revealed her boyfriend had invited two friends over a few nights earlier, and made arrangements for her to have sex with them. He insinuated that doing so would help pay off her debt. Though she complied, she never felt like the sex was consensual. She was also pretty sure money was exchanged, though she never saw a cent of it.
 

As a health-care provider, your focus must be on safety and harm reduction, and letting clients know what their options are."

Leach recognized that Amanda was falling victim to a “Romeo Pimp,” someone who portrays themselves as a romantic interest, then ends up sexually exploiting their alleged partner. She says it’s one of the most common ways people are recruited into human trafficking.

Like the majority of human trafficking victims in Canada, Amanda didn’t self-identify as being trafficked. So Leach had to proceed carefully, and instead focused their conversation on topics like consent, rights, and healthy relationships. She let Amanda know about community services that were available to her, if and when she was ready to leave her current situation. “As a health-care provider, your focus must be on safety and harm reduction, and letting clients know what their options are,” Leach explains.

Amanda was never held physically captive against her will, and Leach says few trafficking victims in Canada are. Instead, she says most are controlled by subtler forms of manipulation. “That’s the scary part,” she says. “You can make people do things they wouldn’t normally do by playing on their vulnerability and making (them) feel they don’t have a choice.”

Though it has been called the fastest growing crime in the world, human trafficking is still largely misunderstood. Many Canadians hear the term and imagine handcuffs and chains on people in a faraway country. But advocates like Leach are working to dispel the myths, raise awareness that trafficking happens regularly in Canada, and help victims get their lives back.

The Canadian department of justice defines human trafficking as “...the recruitment, transportation, harbouring and/or exercising control, direction or influence over the movements of a person in order to exploit that person, typically through sexual exploitation or forced labour.” According to Statistics Canada, there were 206 police-reported cases of human trafficking across the country in 2014. But advocates say this number fails to provide an adequate picture of the problem, since only a small fraction of trafficking cases are reported to police. A 2014 report by the Alliance Against Modern Slavery (AAMS), a Toronto-based not-for-profit, which aims to combat human trafficking and other forms of contemporary slavery, found 551 cases of human trafficking in Ontario alone between January 2011 and December 2013.

Thanks to funding announced this past fall by the provincial government, Leach will be able to provide safe, harm reduction-focused care to even more victims of human trafficking. In September, the province committed $18.6 million to 45 different anti-trafficking projects, including $600,000 to create the H.E.A.L.T.H. (health care, education, advocacy, linkage, and healing) clinic in Ottawa. As an NP with expertise in human trafficking, Leach is leading the first-of-its-kind primary care clinic, which provides health care and social services for people 13 and older who are at risk of human trafficking, are currently being trafficked, or who have been the victims of trafficking in the past. 

With more than 40 people already on its waiting list, the clinic will open its doors in late February. Leach will provide head-to-toe physical examinations, vaccinations, and contraception counselling, while also treating chronic illness and injury, infectious diseases, and mental health issues like post-traumatic stress disorder (PTSD). The clinic will operate under the umbrella of Voicefound, a survivor-led charity for victims of child sex abuse and commercial sexual exploitation, and in partnership with Ottawa Victim Services. Thus the H.E.A.L.T.H. team also includes social workers and peer support workers.

Leach says it’s extremely important to have a dedicated space to provide health care to people like Amanda because of their unique needs. Unlike busy hospitals, which are plagued by privacy issues and bogged down by competing priorities, H.E.A.L.T.H. is designed as a safe space to provide trauma-informed care at a slower pace. “This is health care how it’s supposed to be for these clients,” Leach says, noting research shows care for a victim of trafficking can take the same amount of time as care for 20 domestic violence victims.

In addition to direct care, the clinic also provides education and training for health professionals and other front-line workers. Leach says this will include classroom-based teaching, as well as opportunities to shadow the clinic’s staff to see trauma-informed care in action. 

The clinic is a dream come true for Leach, whose interest in health care for trafficked people began while she was working in an emergency department in the U.S. in the 1990s. After noticing patients coming in with stories like Amanda’s, she did a lot of independent research on the topic, and volunteered with community based anti-trafficking organizations. After returning to Canada in 2003 and studying to become an NP, she met Voicefound CEO Cynthia Bland while they were both part of an anti-human trafficking panel. They hit it off, and looked for opportunities to work together to provide better access to health care for trafficking victims. H.E.A.L.T.H. is the culmination of those efforts. “I’m very excited to have permission to be the kind of health-care provider I want to be,” Leach says.