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The Baylor College of Medicine Resonance Podcast is a student-run podcast aimed at showcasing the science at Baylor through the eyes of young professionals. Each episode is written and recorded by students who have a passion for research and the medical community. Guests on the show include both clinical and basic science research faculty who are experts in their fields. We hope that whoever listens in gains new insight into the exciting world of biomedical research.
Resonance Podcast – Dr. Gordon Episode Transcript
Gianni Calderara:
Hello, and thanks for listening to Resonance podcast, a podcast run by medical and graduate students at Baylor College of Medicine where we interview clinicians, faculty, and researchers about their work in an effort to promote health education and Ingenuity. My name is Gianni Calderara. I am a third-year medical student at Baylor College of Medicine, and I'm going to be the host for this episode.
Today I'm excited to interview Dr. Mollie Gordon. Dr. Mollie Gordon is an assistant professor of psychiatry in the department of Psychiatry and Behavioral Sciences at Baylor College of Medicine. She currently works as the associate director of the inpatient Psychiatry unit at Ben Taub Hospital in Houston, Texas. Much of her work both in and outside of the hospital centers around human trafficking research, service, and advocacy. In 2016 Dr. Gordon founded the Baylor College of Medicine anti-human trafficking program to help treat victims of human trafficking, and she currently serves as the program's medical director. She is also co-founder of the Baylor College of medicine's division of Global mental health.
In this episode, Dr. Gordon will share her experience working with victims of human trafficking as well as how she came to be involved in this work. She will shed light on the current issue of human trafficking both in Houston and across the United States and will provide clinicians with tools and resources to help identify and assist victims of human trafficking.
I was introduced to Dr. Gordon through the Psychiatry clerkship while rotating through the Ben Taub inpatient Psychiatry unit during my second year of medical school. She served as my preceptor for two weeks and often discussed her work within the realm of human trafficking research, treatment and advocacy. Her work serves as a testament to the unseen struggles that many of our patients experience. I hope that through this episode listeners will gain an appreciation for the scope of this issue as well as better understand the steps we can take as a community to advocate for these patients.
And without further ado, let's hear from Dr. Gordon.
Well, Dr. Gordon, thank you so much for being on the show. I got really excited when you agreed to meet with us, and I've been looking forward to learning a little bit more about your work since that time. So thank you so much for being here.
Dr. Gordon:
I'm glad to be here any opportunity to talk about human trafficking to anyone who will listen I will take.
Gianni Calderara:
If you could, would you just start off by telling us a little bit about your background and what brought you to Houston?
Dr. Gordon:
Well, I grew up in Houston, so Houston is home, and I completed medical school and residency at Washington University in St. Louis and then after we had kids and needed a little bit more help raising a family we came home here where all our brothers and sisters and parents are, and it's hard to say no to the best medical center in the world when you have that and family around. So I have been at Ben Taub since 2009, it was my first job out of residency, and I'm not going anywhere. So, it's been an awesome experience; it was a good a good choice.
Gianni Calderara:
And how did you decide on medicine?
Dr. Gordon
Medicine as a field?
Gianni Calderara
Yeah, just has a field or what kind of introduced you to that idea?
Dr. Gordon:
Oh, well lots of things. I like people. I'm a people person. So, I definitely wanted a job where I could be with people and talk to people all day long and not all fields of medicine allow you to be with patients talking to them all day until I got to Psychiatry and I thought oh, this is perfect for me. I could sit here and talk to patients all day long, which is my favorite part about medicine. I liked the Diagnostics and the biology and the science behind medicine, but I think it's really the people that drew me to medicine and their stories. So, Psychiatry was a perfect match.
Gianni Calderara:
So you're currently an associate director of inpatient psychiatry at Ben Taub. I think, you know, for people that are at Baylor or in Houston, we’re pretty familiar with Ben Taub and kind of that patient population, but for our listeners that you know aren't so familiar with Ben Taub, could you kind of just explain a little bit about what your patient population kind of looks like and what working at Ben Taub typically looks like in a given week.
Dr. Gordon:
Sure! We're very busy which is good. We offer a lot of care to patients with acute exacerbations of major mental disorders, and that's what we do on the inpatient unit. We stabilize patients with a huge team. So there's two attending psychiatrists multiple Learners, we have medical students residents and then all sorts of team members that help bring patients back to a well state. So, we have occupational therapists, psychologists, nurses, social workers, case managers chaplains, pharmacist, and then of course our medical and surgical colleagues at Ben Taub who need to step in when patients have concurrent medical and surgical needs.
A lot of our patients are un or underinsured so a lot of them are on the Harris County Gold Card. Sometimes our patients struggle with what is now identified as social determinants of health. So ,access to care barriers, homelessness, sometimes our patients have comorbid substance use disorders or transportation issues or trauma histories, things that make sometimes getting to doctors difficult.
So, I think it's a unique setting for lots of reasons. It's an amazing opportunity to spend a day with patients. Patients are hospitalized and the team is on the unit throughout the day and so to really get to know patients and to see their symptoms and see their symptoms improve is a really unique experience and we're very busy. So typical work week looks like a lot of different things so clinical care, rounds, teaching. We sprinkle some clinical research into that, lectures formal didactics. So, it's a very fun and busy week and patients get better and it's very rewarding for everybody involved I think.
Gianni Calderara:
I know a lot of your work has been dedicated to treating victims of human trafficking and other forms of trauma. Could you tell us just a little bit about how you became interested in that work specifically and kind of your background working with that specific patient population.
Dr. Gordon:
So I actually became very interested in trauma work when I was a medical student. I was a first-year med student during 9/11, some of you guys listening may not have even been born or were in preschool then, and so we lived through the experience of you know, mass disasters. I've always been interested in how the interactions between humans can create disease . So patients are well until something happens to them. And usually it's something inflicted on them by another person. Whether that is terrorism or war or natural disasters or interpersonal violence, it's always been an interest of mine that you can create disease because of interactions between people. So I did a lot of work when I was a medical student with Carol North who I think is now retired, and we did a lot of focus groups of survivors of the 9/11 terrorist attacks and that got me interested in trauma as a construct but more importantly trauma as trauma and resiliency, how do people survive distressing life events and then move forward from them.
Resiliency as a field was sort of just starting then and so it had always been an interest since I was in training, and a lot of the patients that we take care of currently have some form of trauma in their life. You know, I may be dating Myself by telling you this with the original Felitti studies that looked at adverse childhood events, you know didn't come out until the late 90s. I was in college then, so I was just starting medical school. So trauma as a as a comorbidity was just starting as a field. It's been really interesting to watch the understanding of trauma and how it impacts physical and mental health over the last 25 years and be a part of that.
The patients that we take care of have a lot of concurrent traumas and patients with major mental disorders are more likely to be victims of violence and trauma, and so it feels very protective or paternalistic is the term we use as psychiatrists to want to care and work with patients who have been harmed.
We built the human trafficking program because the patient's needed it. It wasn't like I walked into work one day and I thought “what are we doing about trafficking and health systems these days.” The problem came to us as faculty. Back in 2016, we had seen a cohort of patients who were reporting that they had been victims of labor and sex trafficking either as children or as adults, and when we went to the medical literature to look up what we were supposed to do with this, there was a lot of literature in the emergency medicine space and in the health education space, but very little about what we needed to do as psychiatrists and mental health providers to address the primary and secondary prevention of trafficking right. So we built it because the patient's needed it.
We approached the city of Houston. We told them we had an idea about maybe offering a public health model to the city. We received pilot funding to do that. It was successful and then from there, you know from the ashes it developed because there's a need unfortunately. But at least if we're going to educate health professionals on the topic of human trafficking we have a solution which is very empowering as a clinician to have something that you can offer a patient who's been a victim of trafficking.
Gianni Calderara:
Just kind of as a general background and kind of like starting point, could you just go ahead and define what human trafficking is for us?
Dr. Gordon:
Sure. So, we think about trafficking in the clinical space the way policymakers and lawmakers think about trafficking in the International Space. So we think about trafficking in accordance with the United Nations Palermo Protocol or the Trafficking Victims Protection Act which is the United States federal government trafficking laws. And for a person to be trafficked, they have to meet what’s called the AMP model: an act, a means, and a purpose. Those three elements have to be present. So there has to be an act, so the recruiting transferring, transporting, harboring, and receiving of a person doesn't act and that implies movement, like people are recruiting and transferring and harboring people. Like people are moving across the seas or across International lines. Lines are crossed like state lines and that's always that's not always the case. What that act is, is a development of a relationship between a vulnerable person and a perpetrator and that can be family and it can happen in a house. It doesn't have to be a stranger, it often isn't, but it is the development of a an attachment to a vulnerable person and then exploitation of the attachment for financial gain through an element or means of force fraud and coercion.
So A is the act, the recruiting transferring harboring or the development of relationship. M is a means of force, fraud, and coercion and one or all of those elements are often present in that relationship. So somebody may be forced which is a physical element that maybe you know physically assaulted or sexually assaulted or branded something physically happens to them. Fraud is a lie. So they're lied to about what kind of work they're going to be doing whether it's labor work or some sort of work that ends up being sex work and they get frauded or lied to, or they get coerced which is threatened. So they threaten them or someone they love are threatened to retaliate against them. So we call that psychological coercion. And one of those three elements have to be met for the purpose, that's the P in the amp model of Labor or sexual exploitation. So, that's a very long-winded answer, but that’s because a lot of elements have to be present for somebody to traffic someone else. So you have to create a relationship through the means of force fraud or coercion for the purpose of Labor sex.
Gianni Calderara:
I think that's something interesting. You know, I kind of encountered when I was rotating through Ben Taub, this idea of like labor trafficking. I think most people when they think of human trafficking, you know, tend to think more about like sex trafficking, but I know in Texas, you know, labor trafficking is also a very big issue as well.
What are some other examples of how, you know, human trafficking may look differently than you know, kind of what may initially come to mind when we hear that term?
Dr. Gordon:
Yeah, that's a good question.
It's true. Most people think about sex trafficking when they think about human trafficking and they usually think about sex trafficking of minors. I think one of the reasons that is is because when you define trafficking as an act, a means, and a purpose, if you the sexual exploitation of a minor you don't need a force, fraud, and coercion because a minor, whether it's whatever gender, cannot consent to commercial sex acts. So they cannot exchange sex for something of value like food, housing, shelter, clothes, money, drugs, whatever they're exchanging sex for, you don't necessarily need force, fraud, or coercion. So it's a little bit easier to prosecute the sexual exploitation of a minor if the prosecutor doesn't have to prove force, fraud, or coercion. So I think that's why that's one of the reasons sex trafficking gets a lot of attention.
Like any form of exploitation, it's very egregious. But sexualization of minors has always been a taboo subject, and so I think it's always receiving a lot more attention for that reason.
There are lots of different forms of trafficking when it comes to labor trafficking. Things that are pretty common that you would expect in the state of Texas are things like agricultural work or construction work or domestic servitude like home care, but there's also a lot of spaces where trafficking intersects health systems that may not be just in the patient space. So for example, one of our medical students wrote a paper with us about healthcare and supply chains. So are we buying materials in health systems that exploit labor and persons or children worldwide? And what are we doing as health systems to make sure that the products that we use, the pharmaceutical products, the medical products, the papers, the masks aren't contributing to labor exploitation on the global scale. Are we employing people, for example nurses, as part of labor trafficking fraud. There's been a lot of cases in the United States where health workers including nurses have been forced into those positions. So even in our day-to-day work, we probably bump up against labor trafficking. It doesn't have to be in construction sites or in fields.
We also probably underestimate the relationship between intimate violence and trafficking. So we've seen situations where persons are in intimate partner relationships and then are forced to either engage in sex trafficking or sex work or physical work. Let's say whether it's legal or illegal like panhandling, forced panhandling can be a form of trafficking which we don't often think about when we're driving around the city and see people panhandling. Criminality can be a form of trafficking. So you have young boys and Girls who are forced into criminal acts by force fraud and coercion and maybe arrested for criminal endeavors as opposed to identified as being a victim of some form of exploitation. So when we think about trafficking, yes sex trafficking exist. It's a very large problem, but the exploitation of vulnerable populations is really sort of globally what we're talking about when we talk about trafficking.
Gianni Calderara:
Okay. I know it's difficult to like give a specific number about, you know, how many individuals are involved with trafficking and how many victims there are, but could you kind of share any insight as to, you know, how big of a problem this is both in Houston, Texas, the United States, and then also just globally. Like how far does this problem, how large of an issue is this actually?
Dr. Gordon:
It's a very large problem. It's growing. So when we first started in the work it was in 2017, October 2017, the International Labor Organization at that point estimated that there were 40.2 persons globally who were victims of trafficking, the majority of whom were women and children. So it is a gendered phenomenon, but about a third were men. So there's definitely a gender bend to the space, but I think that that's probably a little bit underreported. There's some reasons why I think there are probably more men being trafficked that we probably just aren't identifying. Since then, we have added a lot of interventions to the anti-trafficking space including public health interventions, community outreach, primary prevention strategies, and the numbers have grown from 40.2 to 50.1. So the September 2022 ILO estimates were that there were 50.1 million persons globally being trafficked. So the numbers are rising despite our services and interventions also rising - we're not keeping up.
Gianni Calderara:
Do you think that maybe due to, like, better detection and you know identification on behalf of researchers?
Dr. Gordon:
Yeah, that's a great question. So it may be that we're identifying trafficked persons better, and that's why those numbers are higher. I think that's a great point. It may be that because we have more resources were more likely to ask than maybe 20 years ago or even seven years ago we were less likely to do so. We know that physician or provider-centric barriers to care. Include not asking because there aren't resources and so maybe because we have more resources now we would be more likely to screen. We also have validated screening tools and health systems, which we didn't previously so that may be another reason why we're identifying more.
In the state of Texas, there are not finite prevalence studies but there are estimations. So if you look at vulnerabilities and data that we know where there's high risks of trafficking and then extrapolate a math model from that, the University of Texas Noel Busch-Armendariz and Dr. Melissa Torres in the center of domestic violence there, built a model that was published that estimated there are over 313,000 trafficked persons in the state of Texas, 79,000 of whom were children and the majority, about 264,000 of whom, were trafficked for labor. So the majority is labor trafficking we think in the state, but youth are still being exploited more than they should.
Gianni Calderara:
As a community of educators and, you know, researchers and clinicians, how would you say we could be better at advocating and providing resources for victims of human trafficking?
Dr. Gordon:
Well, listening to this podcast is one way. So you know education is huge. We just hope that people who we rotate with us or work with us think about labor trafficking and sex trafficking as a differential diagnosis of abuse and neglect and harm. So when we think of abuse we think of like child abuse, sexual abuse, physical abuse, elder abuse, why are we not thinking about trafficking as a form of abuse? So just keep adding it to your differential diagnosis.
No matter what field you're in, this perception that trafficking only causes mental health harm we know is not true. Kathy Zimmerman's work at the London School of hygiene and tropical health and many others have documented very diverse health needs of trafficked persons. So if you're going to be a pediatrician you need to know about trafficking because it affects children - peak ages between 12 and 15. If you are going to be an infectious disease doctor, you need to be aware of trafficking because when there's trafficking there's often communicable diseases. Maybe you'll be a head and neck cancer surgeon and during your training you'll see a stab wound to the neck and are you thinking maybe this was trafficking?
So whatever your field is, you will likely see a patient who has been trafficked. Actually a lot of the early literature which came from emergency medicine, OBGYNs, anesthesiologists. We've contributed to literature and written papers in the plastic surgery field and the psychiatry field. If you're going to be a neurologist and a patient comes in with a brain injury, is trafficking on your differential diagnosis? So just keeping it, you know, on your radar is important. What we would love is for clinicians to screen for trafficking the way they screen for other forms of abuse. That's tricky because we need validated screening tools for that, and the only validated screening tools that exist currently are for sex trafficking and in the emergency room setting. But even if we can screen for sex trafficking and adults and children in the emergency room setting, we will have moved the needle because most trainees and students spend time in emergency rooms. And so to learn how to screen in one setting will help sort of continue those skills down the line
Gianni Calderara:
What are some of the other things that, you know, clinicians could be looking out for, you know, some of the common like stories or things, kind of I guess red flags or things to be looking out for when you're seeing patients in clinic or in the hospital?
Dr. Gordon:
Yeah. That's a great question. I wish there was like one red flag, but one of the things we like to teach our learners is that trafficking occurs when there's this sort of convergence of vulnerabilities for exploitation and so is that at the individual level because a person has a lot of individual risk? Is that at the interpersonal level? Is that at the community level? Is that the policy level? When it comes to individual patients, I think that there's probably an overlap between adverse childhood events, social determinants of health, that likely coincide with risk for exploitation.
I'll give you an example, we’re writing a paper with some with some medical students currently on the intersection of food insecurity and trafficking because we don't think about food as being a push factor for exploitation but we learned this from our patients. Our patients have told us that when they have to feed themselves or dependents that trafficking becomes a high-risk endeavor and a choice they may become vulnerable to because it's a way of getting their immediate needs met even at the risk of violence and exploitation.
Gianni Calderara:
I did see on the United States Bureau of Justice statistics some of the data that they published they showed that over the last decade the number of persons prosecuted in the United States annually for human trafficking has actually increased from just over 700 cases to over 1,600 cases per year. I was wondering if you're aware of any policy changes that could explain this increase or could this just be a result of better detection on behalf of prosecutors and researchers?
Dr. Gordon:
That's a good question. I should point out of that that is still a grossly low number of prosecutions compared to victims. It's really hard, I think, to prosecute someone for trafficking because it takes the proof of force, fraud, and coercion, and if that fails then the prosecutors have a case of maybe prostitution or criminal theft or labor abuse that may not elevate to the to the full-blown severity of trafficking. So you want to make sure that you have a trafficking case and then that you can prove those elements of force, fraud, or coercion.
The other issue is that you need a person who's been trafficked. And so people who are trafficked for labor or sex don't always want to get up and testify against their perpetrator. They may fear retaliation. They may be intimidated. Maybe some of the services they receive are dependent on whether or not they testify, so I think laws that allow for hearsay exemption. So for example, if a sexual assault nurse examiner can testify on behalf of a patient instead of a patient.
There's some work, I think her name is Judith. There is a doctor named I want to say, it's Judith Herman, who wrote a great book about restorative justice.
Here it is. Judith Herman wrote a book called Truth and repair. And talks about whether Justice is restorative. Is it helpful to prosecute your perpetrator when you're a victim of labor or sex trafficking for the individual who's been harmed?
So it's a great read if you're interested in that topic.
So I think that you know, there's more awareness to trafficking. I think that's probably why my instinct is that's probably why there's more prosecution if you have more people being identified and people screening more, then they're more likely even, if it's only a small amount that will come to law enforcement, you know a small amount of more still more. So they may be more likely to have more cases because people are screening. There's a lot more community outreach, you know, I've heard stories about you know NGOs and nonprofits in the city going out and doing community educational trainings and person's self-identifying in the audience listening to the lecture and thinking “oh this has happened to me.” And they may not even know that they had been trafficked. So I think education and outreach are definitely valuable and that may contribute to why those numbers are about higher.
Gianni Calderara:
Yeah, I think that's a good point. Obviously better education amongst clinicians and healthcare workers, but also better education among the general population where a lot of individuals may not even be aware that they're being trafficked or that there are programs that could better help them.
We talked a little bit about some of the models in other countries and some of the policy changes that have occurred over the years kind of before we started recording, but are there any specific countries or models that are really handling this issue well, or that we could learn from?
Dr. Gordon:
There's some countries that are doing interesting things. When we think about what countries are doing, there's actually report that's been out since 2001. So for about the last 23 years or so. The “tip” report from the office of trafficking in persons that looks at countries across the globe and then rank them into tiers: Tier 1 2 and 3, and you want to be in Tier 1 because that means you're doing a good job identifying and responding to trafficking and it's less ideal to be in higher tiers because that means you are not doing enough to stop trafficking. There is a model called the Nordic model which comes from the commercial sex work space that seeks to prosecute the buyers of people, whether it's for labor or sex but in the situation is for sex, and it's a demand-reduction model, meaning they think they can arrest their way out of the demand for trafficking which is utopian concept. It's more like whack-a-mole. You know when you arrest one buyer, then that leaves the opportunity for another buyer to take their place in reality.
But Texas has done some really interesting things. So in 2022, there was a bill that passed that criminalized the buying of minors for sex as a felony in the state. And so we're one of the first states to try to criminalize buyers in that manner. And so there's some other really interesting things that Texas has done, actually wrote a paper about it. It's called the Texas model about some of the work that we're doing down here in Texas, which we are flattered by. They say if they write about you, hopefully it’s a good thing. Hopefully they're writing about you for good reasons and not bad reasons. So they're writing about the Texas model.
There's a Texas Bill 2059 that requires healthcare professionals, if they need a license to practice healthcare in whatever field they're in, to get an hour of training in human trafficking. Which is great because the more healthcare providers that get the training, the more likely healthcare providers are to identify trafficking. We know that trafficked persons see healthcare providers during the time they're being trafficked, so somewhere between 65 and 88% of trafficked persons see a healthcare provider during the time they're being exploited for labor or sex.
So if we can train healthcare providers, then maybe we can move the needle. So there are some policies that hopefully will have longstanding impact and good outcomes.
Gianni Calderara:
So let's say a clinician or other healthcare worker is in the hospital or in the clinic, and they start to suspect that a patient may be a victim of human trafficking.
What are some of the steps that that individual can take to advocate for that patient and help them? What are some of the things that they can do?
Dr. Gordon:
Well, the first thing that they can and should do is get their training in human trafficking. I'm gonna send a plug for that. Baylor now has our training online on the Baylor CME and Innovation website. The Center for Innovation has a one hour training available to Baylor faculty and staff on human trafficking. So shout out to Baylor for offering that. So if they suspect that a patient is being trafficked, then they can do lots of different things.
The first thing they should do is let someone on the team know. So share that information with social work, and whether it's a nurse or student or a doctor who's identified, and then the social work team can, or anyone from the team, can call us directly. We have a cell phone that we carry, like a Batman phone, and it's 713-397-1785.
You can put that in your phone, and if you ever come across someone who's been trafficked, you can text it, you can call it, you can email me, you can message our team, recognize HT at bcm.edu. That stands for Recognize Human Trafficking, and that goes to myself and the program director. So if you're in a situation where you're being trafficked, you can reach out to someone in real time, and someone from the team will get back to you. If you need us immediately, call or text us, and we'll call you in real time.
And we've answered phone calls from all across the city, from all different hospitals throughout the day, not only Ben Taub or the Harris Health System. And so it's an early model, and maybe there'll be a better way to do that locally.
There is a National Human Trafficking Hotline.
So the Polaris Project has a Human Trafficking Hotline. It's 1-888-3737-888. So if you're in one of your community clinics, and you don't have your cell phone with you, and you can't call or text me or my team, then you can call 1-888-3737-888.
You can only call that number if the patient consents to allowing you to do that. So keep in mind privacy laws. So if they're an adult and they tell you no, don't call that number and disclose any information.
You can always call that number if you have questions. I'm in Houston. What would I do if I suspected, you know? And they'll ping you back to us.
But it's just good to know what hotline numbers are to call, our cell phone and program number. And then we come up with a plan in real time. So hierarchy of needs.
Is the patient safe and have basic needs like food and shelter? Is the patient medically and psychiatrically stable? Is the patient ready to go into treatment?
Gianni Calderara:
And what are some effective ways or just strategies when you're initially approaching a patient with this discussion or trying to get more information about whether or not they've been trafficked or if they recognize that they've been trafficked, how do you even kind of initiate that conversation with them?
Dr. Gordon:
Yeah, that's a great question. There's a lot of shame and guilt wrapped into survivors of trafficking or people who are currently being trafficked. Patients will tell us that, you know, things like I should have known, it's my fault if I'd known better or if I didn't make that choice.
So I have no one to blame but myself. They don't think to put the onus on the perpetrator of the violence or the trafficking. So we first talk about privacy because of that shame, patients are sometimes hesitant to disclose that they've been trafficked because they don't want other people to know.
So we talk about privacy laws that protect the patient. If they're a vulnerable person like a child or a vulnerable adult that doesn't have capacity, then we are mandatory reporters. So we do have to tell law enforcement.
And that can be difficult if you have a minor who is a teenager, for example, who has shame and also fears disclosure. It's important to tell them that our job as healthcare providers is to provide health services. And we won't, if it's an adult who has capacity, we won't call law enforcement unless they want us to.
And that the reason we're asking isn't to shame or humiliate or to be nosy, but it's because patients may be eligible for services that they may not know about, whether it's housing services, mental health services, victim services, and that part of our duty as healthcare workers is to connect them to those services. And that's why we're asking.
Gianni Calderara:
And I know we talked a little bit about just the anti-human trafficking program you started here at Baylor, but could you just tell us a little bit more about the program and kind of what all it involves and kind of just like how it functions and that sort of thing?
Dr. Gordon:
Sure.
So it started because the HIV field was doing a really good job in developing linkage systems between healthcare systems or linkage services between healthcare systems and community partners. So for example, if you were HIV positive and you came into a hospital, there would be a social worker that you call, that social worker, make sure all of your needs are being met, medical, surgical, housing, mental health needs are being met in the hospital and then connect you to services in the community. And then those services in the community also often have partners, including case managers or social workers.
And so that was a bi-directional relationship. If someone in the community needed health services for HIV, they would come to the hospital. Someone was identified as HIV and needed services in the community, they would then connect to these out.
They're called linkage workers. And I thought, well, that works for HIV patients because HIV patients sometimes have an interdisciplinary team that helps to take care of them the way our patients with trafficking do. So I said, well, we need a linkage worker.
So that was the idea, is to place a linkage worker, a social worker in the hospital. And then we, in our pilot programs, linked that social worker to case managers at the city level through Salvation Army. And then that way it would allow our patients to get their basic needs, like housing met and follow-up care.
And then patients who are identified in the community could get health services through us. They had a direct connection to the health system. But we also felt like the patients needed a lot of time and work in the psychological space.
So we developed a postdoctoral fellowship for human trafficking. So those are PhDs or PsyDs who have completed their training and then do a postdoctoral year with us in clinical care and research in human trafficking. And then the rest of the team is essentially just us, those of us who work at Harris Health and see these patients day to day.
Some weeks we identify a couple of patients a week, which over the years has added up. We've screened over 700 patients. We've probably treated over 500 patients.
So one patient here or there every other week over a long period of time adds up. And it gives us a tremendous amount of data too. It allows us to understand what vulnerabilities patients have, what medical comorbidities patients have so that we can help to serve them.
So who is the team? The team is myself, Dr. Coverdale, who's a psychiatrist at Harris Health, Dr. Fong Nguyen, who's the chief of psychology. Dr. Coverdale and I as psychiatrists work on the medical director and executive director side, respectively, and Dr. Nguyen as the chief of psychology and program director supervises the fellow. And then we all work together with the social worker.
So it's just us, but it's funny, we are busy.
Gianni Calderara:
Is this something that a lot of institutions have or I guess you were surprised that Baylor didn't have or I guess how unique is this to Baylor?
Dr. Gordon:
It's pretty unique. We're the only academic medical center with a postdoctoral fellowship for human trafficking and mental health.
It would be great if everyone had one. And we had, I mean, I guess not great because then that means there'd be a lot of trafficked people who need healthcare, but we would love to have, if not a dedicated social worker or at least a touch point, like a person in each hospital system in the United States who is a champion for anti-trafficking work, whether it's a nurse, a social worker, a physician, a psychiatrist. The American Hospital Association, the AHA, has a group called Have Hospitals Against Violence that's working to try to distribute plans like this across hospitals in the United States to get awareness of violence and sort of champions of anti-violence work at each hospital in the United States.
Gianni Calderara:
And one of the things that I noticed while rotating at Bent Hob and hearing stories from patients and talking to you about this issue was just how sort of emotionally draining a lot of this work can be. I wanted to get your take just on how you've been able to stay grounded over the years and what sort of things that you do to make sure that you're taking care of yourself.
Gianni Calderara:
Yeah, so some of this work, like actually a lot of things in medicine, whether it's surgery, pediatrics, can be distressing.
And so I think some of the ways of coping with those stressors and not having what we call vicarious trauma, which is the word where providers start to have trauma symptoms, intrusive thoughts, flashbacks, nightmares, shifts in worldview, changes in mood that's being impacted by the distress of your daily work is to be very intentional about working when you're working and not working when you're not working and separating work from other activities. Not to try to work all the time. Just turn your phone and your email off at a certain hour every day.
Have time with your friends and family in the evenings, on the weekends. Find something that helps alleviate stress, whether it's exercise. I'm not an athlete.
I'm sure that's a surprise to you. But I went back to art school a few years ago. And so that's been tremendously helpful to have time every week where I get to paint.
So that has been really more helpful than I thought it would be. And so I think self-awareness is key, recognizing that one of the ways of preventing burnout is to recognize when your work is taking an emotional and physical toll on your health. And then doing something about, more importantly, developing an action plan to do something about it.
I always say that with that resiliency built up, then you'll be able to work longer. Even if you have to take a little bit of time out of every day or every week. To slow down.
Yeah, for self-care. Then you'll be able to be doing the work for longer periods of time. And we hope to be able to be doing this work for a long time.
Gianni Calderara:
I did want to mention, while I was researching for this episode, I did come across an article that was written about you several years ago that sort of detailed your lifelong passion for reading. And I was hoping to end the episode, you could just give us either a book recommendation or another piece of literature for someone who may want to learn more about human trafficking.
Dr. Gordon:
Yeah, so actually the book I'm currently reading and the book I read last week, both actually happen to be related to trafficking.
I wonder if that's why people referred both books to me. The first actually won a Pulitzer. It was Demon Copperhead by Barbara Kings Oliver.
And I don't want to ruin the book for you, but it's about the fentanyl crisis in the Appalachian community and how it came to be. And one of the characters is a young boy who is labor trafficked. He's a vulnerable youth.
He is in the foster system. And it talks about how a child's social circumstances makes them very vulnerable to be exploited so easily and unprotected. So I think that is a beautiful and well-written book.
And then I'm reading a book that's a little bit more sad. I guess it's relative, right? It's called A Little Life by Hanya Hanagihara. I think it was a Man Booker Prize winner or finalist in 2015.
So I'm only getting around to it now. And it is a very beautifully, a very beautiful book about how children without trusted adults can be, which as we know is a protective factor against kids getting exploited, that children who don't have a trusted adult can be harmed and the physical and mental health harm that that has on a person. What resiliency looks like and what the value of a trusted adult brings to the table when you talk about recovery.
So both are excellent books. So I recommend them both.
Gianni Calderara
Okay, and then what about a book that has nothing to do with trafficking?
Dr. Gordon:
Oh, maybe something less distressing.
If you don't wanna work in the anti-trafficking space then go home and read about trafficking all day. So I'm also reading Jhumpa Lahiri's short stories. She was in town recently with the University of Houston imprint program.
And so she just came out with her first book in Italian. She's one of my favorite authors. She wrote the namesake and has won a Pulitzer when she was in her twenties.
And it is her first book written in Italian and it's called Rome Stories. It's a book about ordinary things. And it's just, she's a beautiful writer.
So if you're looking for just some good reading but you only have maybe a little bit of time to commit to a story instead of a whole novel, you can sort of eat, you know, read each story in chunks. So I recommend that book.
Gianni Calderara:
Sounds good.
Dr. Gordon:
Five stars for sure.
Gianni Calderara:
All right, well, I think that's all the questions that I had. Dr. Gordon, thank you so much for taking the time to come and talk to us and kind of share about your work. Really appreciate you being here.
Dr. Gordon:
Thank you for having me and for all the listeners out there.