Traffickers targeted and enticed the four women in Cuba, promising them a better life in the United States and then loading them onto a boat for the journey across the Florida Straits. But when the women arrived in Miami, the deal went sour. They would have to work as prostitutes to pay off an exorbitant transportation debt, traffickers told them. And that meant having sex with as many as 20 men a day in brothels and illicit massage parlors.
When JoNell Potter, a University of Miami Miller School of Medicine nurse, first heard about the four women, they had already been rescued and sheltered by the U.S. Department of Homeland Security (DHS). It wasn’t enough that they were now safe and had a place to stay. The women needed medical care, and DHS asked Potter if she could help.
At the time, it didn’t seem like a daunting request, certainly nothing that Potter—a professor of clinical obstetrics, gynecology, and reproductive sciences—couldn’t handle. After all, in the early 1980s, when the HIV/AIDS epidemic emerged in Miami, she was one of the first health care workers on the frontlines, helping to design a comprehensive, multidisciplinary model of care that allowed women and children living with HIV to access medical services.
She would quickly learn, however, that these patients, and others like them that DHS and local law enforcement agencies subsequently brought to her for treatment, presented a whole new set of health care challenges beyond the scope of anything her team had in place. They had been trafficked from city to city, often beaten, abused, and, in some cases, branded with tattoos by their pimps to show ownership.
“It was not just a matter of performing a simple GYN exam. They had experienced trauma, and they had tremendous medical care and mental health needs,” Potter recalled.
Even the simplest of tasks were a challenge for them.
“We realized fairly early on, for example, that they couldn’t sit in a waiting room,” she said. “I would sit next to them, and I could see the anxiety start to mount because there were too many people, and they had been brainwashed into thinking the traffickers were going to come looking for them. And if not the traffickers, people who were working for the traffickers. They were even worried that some of the men in the waiting room might be former Johns.”
Potter had already assembled a cadre of providers—nurse practitioners, physicians, and psychologists—who were all willing to help. But what was needed most, she knew, was a dedicated space just for the survivors.
So, she called the county’s top prosecutor, Katherine Fernandez Rundle, Miami-Dade state attorney.
“She advocated on our behalf,” Potter said of Fernandez Rundle’s efforts. “She made it clear that there was a gap in health care access for these patients and that they desperately needed specialized, trauma-informed health care services.”
Shortly after, the Trafficking Healthcare Resources and Intra-Disciplinary Victim Services and Education (THRIVE) was born.
A collaboration between the Miller School of Medicine and Jackson Health System, the clinic, which Potter describes as “a one-stop shop” for human trafficking victims, provides everything from primary and gynecological care to psychiatry and behavioral health services under one roof.
DHS, the Human Trafficking Unit of the Miami-Dade County State Attorney’s Office, and other antihuman trafficking organizations refer victims to the clinic.
Comprehensive care
But what makes this model one of the first of its kind is the way it administers health care, starting with the way patients are brought in and the manner in which their medical histories are taken.
There is no waiting area—patients are admitted and discharged inside the examination room.
“This isn’t the way medicine usually operates,” said Panagiota Caralis, a professor of medicine at the Miller School and medical director for THRIVE. “You never have a registration, an exam, and a discharge in one place. But it’s been done that way in recognition of the sensitivities of these patients.”
While most of the patients need care from multiple specialists, THRIVE never requires them to navigate a maze of medical facilities. The providers come to them. In addition, repeating past experiences can re-traumatize survivors.
“So, we take a medical history only once and ask every provider to review it before they meet the patient,” said Potter. “We’ve learned that no medical history is routine. Survivors often cannot remember or do not want to remember. Their stories change over time. They aren’t lying. They have blocked out the trauma to survive.”
From illnesses that have gone untreated for years to broken bones that didn’t heal properly, their health care needs are intractable, with mental health care being the most critical need. Many of them, said Potter, have post-traumatic stress with all the classic symptoms—flashbacks, nightmares, depression, and suicide attempts.
“We can’t just say, ‘Okay, I’m going to treat your hypertension and send you on your merry way.’ It doesn’t work that way,” said Caralis, who is also medical director for women veterans health at the Miami Veterans Administration. “The mental health piece is key to having them come back into the community as productive people who are able to function on their own and not fall back because there is no other choice. It’s going to take role models and peers to help them make it. And we’re looking at a program to try and do that,” she added.
Each referral, and successful treatment, is a victory of gargantuan proportions for the THRIVE team, as they have painfully come to realize that even getting survivors to walk through the clinic’s door hinges on law enforcement’s ability to rescue and persuade victims to cooperate.
And accomplishing that task, said Fernandez Rundle, can be exceedingly difficult. What the trauma victims endure leaves them vulnerable to manipulation by traffickers, who instill in them a fear of talking with police and reporting their situation.
“Many are unwilling to cooperate for fear of retaliation,” she said.
Much like Potter was once unaware of the serious health consequences trafficking victims face, Fernandez Rundle’s office found itself at a similar disadvantage eight years ago after learning that Florida ranked No. 2 in the nation for human trafficking cases, with Miami one of the primary hotspots.
“Back in 2012, my office had virtually no cases of human trafficking,” she said. “So, we set out to learn and understand what it actually was, who and where the victims were, and where in Miami-Dade the predators were.”
Her office established a human trafficking unit and a task force made up of police officers from multiple agencies. Soon, their caseload of human trafficking-related cases mushroomed, going from only three in 2012 to more than 600 today. In that same time span, her office has worked with more than 700 victims.
Fernandez Rundle called the partnership with THRIVE invaluable, saying the clinic has helped victims heal and become strong enough “to break the emotional chains of their enslavement and be an effective part of a criminal prosecution.”
THRIVE physicians, nurses and social workers, explained Potter, have been able to break those “emotional chains” by building trust with the victims, employing patient navigators—usually survivors themselves who have reentered the workforce—to chaperone patients through each clinical visit.
Latoya Johnson, program director for THRIVE, and Shanika Ampah, nurse and patient navigator
A mother’s story
One of those patient navigators is Shanika Ampah, a mother of nine.
Sexually abused as a child, she ran away from home at the age of 11 and became ensnarled in a vicious web of prostitution and human trafficking. She was traded among pimps from neighborhood to neighborhood.
The farther away Ampah got from home, the farther away hope seemed to be.
“When I was being trafficked, it wasn’t a 9 to 5 situation,” she said. “The beatings came at 3 in the morning when you didn’t make your quota.”
There was no THRIVE clinic back then, and other avenues of help were just as scarce.
At 18, Ampah got pregnant, and that’s when things started to turn around. “What really changed everything for me was my children and getting back into school,” she said.
She became a medical assistant and then a licensed practical nurse, taking a giant step toward becoming independent.
One day, Ampah got a call from a DHS worker, who told her that THRIVE needed a patient navigator and that she would be an ideal fit for the job because her background and medical training would allow her to relate to, and help, patients. Since then, working at the clinic has been one of her passions.
“I can empathize with them; empower them and let them know that this is just one moment in their lives that shouldn’t define them and that they can overcome it,” she said. “I always ask them, ‘What was it that you wanted to be before all of this happened?’ For me, I always wanted to be a teacher or a nurse.”
Ampah has seen the most extreme cases—mothers who have lost custody of their children, patients diagnosed with terminal illnesses, a woman who is going progressively blind because a pimp threw acid on her face.
She tries to change their mindset. And as an outreach coordinator, she visits those hotbeds of prostitution where she once walked, from Southwest 8th Street to Biscayne Boulevard, going into dark alleys to share resources and her story and discreetly letting victims know that help is available. She is street savvy enough to know how to avoid confrontations, fully aware that traffickers and pimps could be watching.
Through her nonprofit, Guiding Light Outreach, Ampah spends as much time as she can educating the public, not only about human trafficking, but about social issues such as poverty, homelessness, and illiteracy. Things that make women vulnerable to becoming victims of a criminal enterprise that generates global profits of $150 billion a year—nearly $100 billion of which comes from commercial sexual exploitation.
Ampah has spoken on local radio stations HOT 105 (WHQT) and 99 Jamz (WEDR), spreading her message.
She never powers down her cellphone. Once, she got a call at 3 a.m. from a victim who was being arrested. The next day, Ampah was in court to advocate for the woman.
“They need someone to have their back,” said Ampah. “It’s so easy to fall back into that cycle.”
It shouldn’t take a Super Bowl coming to Miami to shine a spotlight on the problem, Ampah said. “We have Ultra, spring breaks, boat shows, a Memorial Day weekend celebration—human trafficking is here year-round,” she said.
Keeping it afloat
Not all of Potter’s battles have been fought advocating for and administering care to survivors. It has also been a fight for funding. While a grant from the U.S. Department of Justice’s Office for Victims of Crime supports some aspects of the clinic, grants do not cover everything—and they don’t last forever, leaving the clinic with the challenge of finding additional support to sustain services. So, donations have helped take up the slack.
THRIVE is being replicated in at least one other Florida county and in Atlanta, where Juhi Jain—a Miller School alumna currently in the second year of a pediatric hematology/oncology fellowship at Emory University’s Children’s Healthcare of Atlanta—is working with a team of physicians to establish a health care and victim services model.
Five years ago, it was Jain who sowed the seeds for what would become THRIVE, when she applied for and received an Arsht Research on Ethics and Community Grant to educate health care professionals about human trafficking through educational seminars.
“I saw the need to educate providers, so I worked with my mentors at UM to make it happen,” said Jain, singling out Caralis, a professor of medicine, who is also a School of Law alumna and director of the Health Law pathway that integrates education in health and law for medical students, residents, and fellows.
Potter said THRIVE is succeeding, noting the low recidivism rates among patients.
“Our patients,” she said, “are successfully reengineering their lives.”
