The modern-day version of slavery is thriving in the United States, and some human rights advocates are trying to help health care providers stop it.

Though it is often viewed as a non-U.S. problem, human trafficking, as it’s called, is taking place all across the country. “Any large city, particularly hubs for transportation, is where we’re going to find domestic trafficking victims,” says Douglas Chin, M.D., director of outreach for Physicians Against the Trafficking of Humans, or PATH, a committee of the American Medical Women’s Association. Chin also is chief of the division of hand surgery at Alta Bates Summit Medical Center, Oakland, Calif.

He says places like the San Francisco Bay area, Los Angeles, Houston, smaller cities in Texas, Chicago, Detroit and New York are known to be trafficking hubs.

And the domestic trafficking, largely for sex, can involve children who are as young as 5 or 6. “It’s horrendous,” Chin says.

At press time, federal legislation aiming to crack down on the practice was awaiting a signature by President Obama. Still, physicians, nurses and other providers are among those in the best position to identify victims of human trafficking.

Until recently, awareness of the problem has been relatively limited. Chin himself says he became involved in fighting the practice domestically while he was working with his church to combat it overseas. Then one day, he was treating a patient with dislocated thumbs, a fairly rare injury. She also had gray marks all over her body and a number of unusual tattoos stating that she was somebody’s girl. “I didn’t really think much of it,” Chin says.

He later learned that she was being trafficked and the tattoos were a brand indicating she was owned by the person named in the tattoo — likely a pimp — and the gray marks were an after-effect of chronic beatings.

“I missed that,” Chin says. “It was a missed opportunity to really make a difference in this girl’s life,” he says. That’s when Chin turned his focus to fighting domestic trafficking.

Like the tattoos Chin missed, there are other indicators of potential trafficking.

“The most important thing is for physicians to be aware of a constellation of red flags,” says Holly Atkinson, M.D., co-chair of PATH. Atkinson also is assistant professor of medicine and preventive medicine, and director of the Human Rights Program, Arnhold Global Health Institute at Mount Sinai Hospital, New York City. PATH has a number of resources and educational tools available on its website, as does a broader-focused group called Polaris.

The desire to increase understanding of how to identify victims of trafficking, including children, has prompted a push for more education in physician training.

“We’re starting to see changes in medical school curricula,” Atkinson says.

PATH also recently sponsored a physician training session in the San Francisco Bay area that was attended by dozens of providers.