Pregnancy and nail salons
From the triage notes I can see that my next patient will be a 21 year old female, 8 weeks pregnant, vaginal bleeding. Before I see her, I note that all her observations have been normal since she arrived. Any blood loss therefore, is not currently substantial enough to result in a compensatory quickening of the heart and breathing, or decompensatory drop in blood pressure. She’s able to walk, talk, perfuse her brain and other organs with oxygen, so I take her into a side room.
She’s young and timid, of Asian origin. She tells me she’s from Vietnam originally. Her English is good, and she’s alone. I guess I won’t have any problems asking the more sensitive questions. No one to ask to leave the room. She seems quiet, but confident, unambiguous. Replying with the minimum number of words, yet yielding any requested information. I’m struggling to get a rapport with her, but I can’t figure out why.
She feels well in herself, but her recent bouts of morning sickness prompted a pregnancy test. Her last period was about 8 weeks ago and so I guess, that’s how many weeks she must be. The bleeding started this morning, all of a sudden. Fresh red and small clots, nothing else. No abdominal pains, chest pain, shortness of breath, urinary or bowel symptoms. First pregnancy, only condoms used, unplanned. Never had any gynaecological problems or surgeries on her tummy.
The clinical questions roll off the tongue, and I ask what I need to ask. A few targeted questions about her sexual history is enough from an emergency point of view.
Amongst these last questions, shouts can be heard in the background from a patient having a psychotic episode. They’ve been in the department now for 12 hours awaiting a bed in the psychiatric ward, three people following them round and round the department in their wake. I’m used to this, but she isn’t and she gives me a nervous smile before looking down.
I feel her pulse, neither bounding nor thready. Her inner eyelids are pink and not anaemic. I examine her chest, heart sounds and lie her flat to feel her tummy. Reassured that she’s pain-free, she sits back up.
I’m not sure what is niggling in the back of my mind. Whilst I examine her, I realise that her confidence and nonchalance has really thrown me off. I haven’t considered that she’s a young Vietnamese woman who is newly pregnant. Maybe there’s nothing to consider, but what if there is and I haven’t given her the chance to tell me. Am I stereotyping or being informed and cautious?
In the area around my hospital there was rows of nail salons. Almost every other shop has signs declaring, “Nails for £10” and new discounts and deals. Cheap, neon lighting, glaring signs and a quiet row of Vietnamese men and women with masks on painting and painting.
My stomach churns when I walk past them, because I know that Vietnamese men and women have been identified in salons like these. Forced to work for little to no pay, passport and documents taken, indebted to their traffickers who paid for their travel, visas and accommodation. Unable to leave due to threats to their families, physical beatings, and told they’ll be turned over to the authorities and deported. Often forced to work in the salon by day and forced to sell sex against their will by night. Real life slaves in the modern day.
“What do you do for work?” I ask cautiously, trying not to give away that I’m screening for exploitation.
“I work in a nail salon”. I’m nervous now, because I need to ask the questions that I teach others to ask during my safeguarding training programme. I am less practised in asking these questions and it still feels unnatural to me. I wonder if that will be apparent. They’re important though and I can’t expect others to start screening for modern slavery, abuse and exploitation if I can’t even ask these questions myself.
“Are you paid for the work you do?” I look into her eyes, sincere and genuine. It’s been difficult to gain a rapport with her, but hopefully she knows I care. “Yes.”
“Are you free to leave your job if you wanted to?” “Yes I am.”
“Is there anyone you feel threatened by, at work or a relationship?” “No.”
“Ok, well if you ever feel afraid or threatened then you can always tell one of us. You can always come to A&E and you will get help if you need.”
I don’t know whether I should say more, but I feel naturally like this is enough. I won’t ever know if she’s being exploited or paid well and in a comfortable environment. I don’t feel there is any more I can do, but the uneasiness has lifted in my mind. I explain the plan and next steps to her, walk her back out to the waiting room and head over to the desk to write my notes and gather my thoughts.
