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Outlining the Intersection between Health Care and Missing and Murdered Indigenous People

by Nicole Stahlmann, MN, RN, SANE-A, AFN-BC, SANE-P, FNE-A/P, Forensic Nurse Consultant, Division of Nursing Services

To my fellow colleagues – violence is and will remain a health care issue. Alarmingly, an average of 40 percent of women involved in sex trafficking are identified as American Indian and Alaska Native. The unfortunate health consequences for those engaged in sex trafficking include rape, unwanted pregnancy, contracting sexually transmitted infections, depression, anxiety, being physically assaulted, suicidal ideations, and becoming victims of homicide. Homicide is the third highest cause of death for Native girls aged 15 to 19 and women aged 20 to 24. In some communities, American Indian and Alaska Native women face murder rates more than 10 times the national average. Sharing these statistics creates a commonplace mentality that does not truly honor every victim, family, or community impacted by violence and oppression.  

Individuals who experience victimization, such as sexual assault, domestic and intimate partner violence, stalking, human trafficking, and other situations could potentially become victims of homicide. With human trafficking being at the core of the Missing and Murdered Indigenous People crisis, we are seeing thousands of patients come through our facility doors however, the majority of eligible patients do not receive a safety screening (see the IHS GPRA Report Summary for 2023.) Failing to screen patients leads to missed opportunities to properly treat, diagnose, and offer culturally appropriate resources. Screening patients, providing education, and offering appropriate resources can lead to healthier patient outcomes, such as support and empowerment to raise their physical, mental, social, and spiritual health and well-being.

As providers, let’s be proactive! Obtain the training needed to enhance the quality of care that we provide to individuals impacted by violence. Develop health care policies that provide care for patients following sexual assault, sexual abuse, domestic and intimate partner violence, physical violence, or trafficking situations. Create a warm, welcoming, non-judgmental, trauma-informed atmosphere during every patient encounter. Actively conduct safety screening for every eligible patient using a validated, evidence-based screening tool for domestic and intimate partner violence (e.g., HARK, HITS, E-HITS, PVS) and human trafficking. Offer every patient holistic, patient-inclusive, culturally appropriate safety planning and education that meets every individual’s needs. Ask the patient how can I/we best support you and your needs at this time? Support and respect the patient’s wishes to control their own care, such as their desire to coordinate with traditional healers. Engage with a coordinated community response and multidisciplinary team and connect with one of the 20 tribal sexual assault/domestic violence coalitions. Lastly, please reach out to the MMIP Regional Coordinators. We are stronger through connections, and we are stronger in community!

Each year, May 5 is recognized as Missing or Murdered Indigenous Persons Awareness Day. We ask that you please wear red to show your ongoing support and dedication, to help honor victims, and to raise awareness and call for an end to this crisis.  

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For providers:

Nicole Stahlmann, MN, RN, SANE-A, AFN-BC, SANE-P, FNE-A/P, Forensic Nurse Consultant, Division of Nursing Services
Nicole Stahlmann, MN, RN, SANE-A, AFN-BC, SANE-P, FNE-A/P, serves as the forensic nurse consultant with the IHS Division of Nursing Services. Prior to her work with IHS, she served as a forensic nursing specialist with the International Association of Forensic Nurses and was the clinical program manager for the District of Columbia Forensic Nurse Examiners. Stahlmann was an emergency department nurse and adjunct instructor, teaching both undergraduate and master prepared students at Georgetown University. She continues to practice. clinically, providing care for patients who have experienced violence