Essay about American citizenship "I Love America"

Reflections on citizenship- Echo opinion letter published in The County, an Aroostook County newspaper, in Maine.

https://thecounty.me/2025/07/11/houlton/reflections-on-citizenship/

To the editor:  I love America.

This year I enjoyed my first Fourth of July celebration since becoming a U.S. citizen, at ceremonies help this past April. 

I have been reflecting deeply on what it means to be a citizen. 

For me, citizenship was not something simply given; it has been a journey that took 19 years. But beyond the length of time, it has been about understanding its meaning.

I was born a citizen of South Korea, which does not allow dual citizenship for males due to mandatory military service. 

I had to make a choice. After much thought and prayer, I chose to become a U.S. citizen. For me, it was not about gaining privileges, but about becoming one of the people I serve as a pastor.

As I prepared for citizenship, I reflected on two ways about belonging to a nation: nationalism and patriotism.

Nationalism is often rooted in fear of others. It elevates the concerns of “my people” at the expense of those who are not. It excludes those deemed outsiders. Patriotism, on the other hand, is love for one’s people and community. It brings people together for the common good. It celebrates what is virtuous while speaking truth about what is unhealthy or unjust.

I love America. I love its people. I celebrate its diverse cultures and ways of life. Out of love, I will speak truthfully about its failures. 

I will care for the poor and for immigrants. I will seek to be a bridge builder for social and racial justice and reconciliation. I will be a good steward of the planet. I hope to live as a patriot, not a nationalist.  May God bless America.

From SeungRi “Victor” Han, in Houlton, Maine

Donald Trump and Elon Musk are throwing American democracy under the proverbial political bus!

Echo opinion letter published in Democracy Docket by Marc Elias:

Dear Musk:  I used to be a regular on Twitter (now X/com !), where I amassed over 900,000 followers — all organic except for the right-wing bots who seemed to grow in number. Like many, I stopped regularly posting on the site because, under your evil stewardship, it became a hellscape of hate and misinformation.

Also, I used to buy your cars — first a Model X and then a Model S — back when you spoke optimistically about solving the climate crisis. My family no longer owns any of your cars and never will.

But this is not the reason I am writing. 

You don’t know me. You have no idea whether I suffered trauma and if I have, how it has manifested. And, what's more, it’s none of your business❗

My family as new immigrants, life wasn’t easy. We lived in cramped housing without hot water. They worked menial jobs — the kind immigrants still perform today.

Some may look down on those immigrants — the ones without fancy degrees — but my family was proud to work and grateful that the United States took them in. They found support within their Jewish community and a political home in the Democratic Party.

I became a lawyer to give back to the country that gave my family a chance. I specialize in representing Democratic campaigns because I believe in the party. I litigate voting rights cases because the right to vote is the bedrock of our democracy. I speak out about free and fair elections because they are under threat.

Now let me address the real crux of your post.

You are very rich and very powerful. You have thrown in with Donald Trump. Whether it is because you think you can control him or because you share his authoritarian vision, I do not know. I do not care.

Together, you and Trump are dismantling our government, undermining the rule of law and harming the most vulnerable in our society. I am just a lawyer. I do not have your wealth or your platform. I do not control the vast power of the federal government, nor do I have millions of adherents at my disposal to harass and intimidate my opponents. I may even carry generational trauma.

But, you need to know this about me. I am the great-grandson of a man who led his family out of the shtetl (a small Jewish town in Eastern Europe before the Holocaust) to a strange land in search of a better life. I am the grandson of the three-year-old boy on that journey. As you know, my English name is Marc, but my Hebrew name is Elhanan (אֶלְחָנָן) — after the great warrior in David’s army who slew a powerful giant.

I will use every tool at my disposal to protect this country from Trump. I will litigate to defend voting rights until there are no cases left to bring. I will speak out against authoritarianism until my last breath.

I will not back down. I will not bow or scrape. I will never obey.

Defiantly, from Marc Elias

However, I will address your last point about generational trauma. I am Jewish, though many on your site simply call me “a jew.” Honestly, it’s often worse than that, but I’m sure you get the point. There was a time when Twitter would remove antisemitic posts, but under your leadership, tolerating the world’s oldest hatred now seems to be a permissible part of your “free speech” agenda.

Like many Jewish families, mine came to America because of trauma. They were fleeing persecution in the Pale of Settlement — the only area in the Russian Empire where Jews were legally allowed to reside. Even there, life was difficult — often traumatic. My family, like others, lived in a shtetl and was poor. Worse, pogroms were common — violent riots in which Jews were beaten, killed and expelled from their villages.

By the time my family fled, life in the Pale had become all but impossible for Jews. Tsar Nicholas II’s government spread anti-Jewish propaganda that encouraged Russians to attack and steal from Jews in their communities. My great-grandfather was fortunate to leave when he did. Those who stayed faced even worse circumstances when Hitler’s army later invaded.

That is the generational trauma I carry. The trauma of being treated as “other” by countrymen you once thought were your friends. The trauma of being scapegoated by authoritarian leaders. The trauma of fleeing while millions of others were systematically murdered. The trauma of watching powerful men treat it all as a joke — or worse.

So MUSK, As an immigrant yourself, you no doubt sympathize with what it means to leave behind your country, extended family, friends and neighbors to come to the United States. 

Of course, you probably had more than 86 rubles in your pocket. 

You probably didn’t ride for nine days in the bottom of a ship or have your surname changed by immigration officials. The ship's manifest shows that Aron, age three, was my grandfather.

JD Vance says he must lie to get attention in the media but his evil hersay puts innocent people at risk of harm

Republicans DEMEANING behavior: Echo opinion letter published in the Kansas City Star newspaper:

HELLO? I love cats.

Most people I know love cats. Vice presidential Republican candidate J.D. Vance spreads false rumors about cats being eaten by Haitian immigrants in Springfield, Ohio, and DonOLD Trump further promoted the idea in the presidential debate last week. This unfounded claim is based on wild internet hearsay and has been refuted by local police and other officials. 

The issue is not that one preposterous allegation has appeared online, but rather that it has been given extended life by a major (Republican❗) political party, including its members of Congress and candidates for president and vice president. 

Could this be part of their ongoing efforts to brand immigrants and people of color as those to be feared and hated? I guess they find their claims that immigrants are criminals, drug dealers, rapists and worse are not sufficient, so they resort to accusations of cat-eating.

Absurd. Can they possibly stoop any lower❓ 

From Sheryl Rose, St. Louis

Republican party is dysfunctional

The Republicans’ demographic trap:

Echo opinion essay published in the Boston Globe by Thomas E. Patterson.

Republicans are sitting on a demographic time bomb of their own making, and it could send them into a tailspin.

Vote Democrat 2024 #VoteBlue

Republicans were in office and were widely blamed when the Great Depression struck in 1929. The Grand Old Party lost the next three presidential elections by wide margins. 

But, it was a related development during the period that ruined the GOP‘s long-term prospects. First-time voters backed the Democratic Party by nearly 2 to 1 and stayed loyal to it. Election after election until the late 1960s, their votes carried the Democrats to victory.

In only one period since then have young voters sided heavily with one party in a series of elections. Voters under 30 have backed the Democratic presidential nominee by a 3-to-2 margin over the past four contests. And as they’ve aged, these voters have leaned more heavily Democratic while also turning out to vote in higher numbers. They now include everyone between the ages of 21 and 45 — more than 40 percent of the nation’s adults.

Republican House is politically dysfunctional 

Republicans are sitting on a demographic time bomb of their own making, and it could send them into a tailspin. Although the politics of division that Republicans have pursued since Richard Nixon launched his “Southern strategy” in the late 1960s — a blueprint to shore up the vote of white Southerners by appealing to racial bias — has brought new groups into their ranks, including conservative Southerners, evangelical Christians, and working-class whites, it has antagonized other groups.

Republicans are paying a stiff price for defaming immigrants. If they hadn’t, they could have made inroads with the Latinx population. Although most Latinx have conservative views on issues like abortion and national security, they vote more than 2 to 1 Democratic. A 2019 poll found that 51 percent of Latinx believe that the GOP is “hostile” toward them, with an additional 29 percent believing that the GOP “doesn’t care” about them.

Asian-Americans have also turned away from the GOP. They are America’s fastest-growing ethnic group and have the profile of a Republican bloc. They have the nation’s highest average family income and are twice as likely as other Americans to own a small business. As late as the 1992 presidential campaign, they voted 2 to 1 Republican. Today, they vote more than 2 to 1 Democratic.

Without the vote of white evangelical Protestants, the GOP would already be a second-rate party. Eliminate the evangelical vote in the 2016 election and the GOP would have received barely more than 40 percent of the popular vote. Even the GOP’s reputation as a “white” party owes to evangelicals. Non-evangelical whites voted Democratic by a 53-47 percent margin in 2016. Moreover, white evangelicals’ ability to prop up the GOP is declining. America’s fifth wave of religious revival began to wane two decades ago. White evangelicals now constitute a sixth of the population, down from a fourth in the 1990s.

There was no gender gap until the GOP adopted evangelicals’ version of family values, including opposition to abortion. Women are now the Democrats’ largest voting bloc, and their loyalty has increased, reaching record highs in the 2016 and 2018 elections. And Republicans’ embrace of evangelicals’ position on gay rights has alienated the LGBTQ community. They are now second only to Black Americans in their Democratic loyalty. The GOP’s rigid stance on social issues has also eroded its standing with college-educated voters. Once heavily Republican, most of them now side with the Democratic Party.

To assess the threat of demographic change to the GOP, I projected the outcome of future elections based on the US Census Bureau’s population change estimates. The Republican Party faces a dim future, as the groups supporting it shrink in size while those opposing it grow in number. 

By 2032, Democrats would have a 59-to-41 percent edge based solely on population change.

A maxim of two-party politics is that a party needs to be inclusive — a big tent — to be competitive. Whatever the short-term advantage of the GOP’s politics of division, it is now facing the fallout. Millions of younger adults, women, Blacks, Latinx, Asian Americans, LGBTQ, and the college-educated will be pulling the Democratic lever for years to come.

Thomas E. Patterson is a professor at the Harvard Kennedy School’s Shorenstein Center. This series is adapted from his book “Is the Republican Party Destroying Itself?”

Texas immigrants can be welcomed in communities outside of sanctuary cities

Echo opinion by Evan Weidl, published in The Daily Iowan newspaper.

Iowa City should accept Texas migrants:  Immigration strengthens communities, and Iowa City should welcome them in.

"Iowa City is a compassion­ate, accepting city, and we should always be prepared to provide for those in need."

Immigrants are the foun­dation and life blood of the U.S., and Iowa City has the chance to prove its commit­ment to the belief that immi­grants make our communi­ties stronger.

Texas Republican Governor Greg Abbott bused 10,000 migrants to sanctuary cities across the country, including Chicago, New York, and Washington, D.C. There were questions about whether Abbott would send any migrants to Iowa City, but Governor Kim Reynolds’ office confirmed that would not be the case.

Even though Texas will not bus any migrants directly to Iowa City, we as a commu­nity and government should always be prepared and will­ing to welcome them.

In recent years, Iowa has seen more people leave the state than move into it. Iowa ranked tenth in the U.S. with the most outbound people, according to the 2019 National Movers Study by United Van Lines. That said, Iowa should be more than happy to welcome more peo­ple in.

Iowa City would certainly not be the distinctive place it is without the contribu­tions of immigrants. Thanks to their restaurants, stores, and businesses, Iowa City is a much better place. According to Best Neighborhood, Iowa City is “much more diverse than most U.S. cities,” earn­ing a diversity score of 90 out of 100.

Immigrants make signif­icant contributions to the culture and life of Iowa City. Community events like the annual Latino Fest are an excellent opportunity for the community to come to­gether and appreciates cul­tures.

Additionally, accepting migrants would help lighten the burden being put on oth­er sanctuary cities across the country. While we would not be able to take in as nearly as many migrants as cities like New York or Chicago, our ef­forts combined with other sanctuary cities across the country would make taking care of the Texas migrants more sustainable.

Those opposed to taking in migrants may cite safety concerns as a reason to not accept them. While Iowa City passed a resolution in 2017 stating the city would not use law enforcement toward federal immigration law, ex­ceptions would be made for cases of public safety and vi­olent offenders.

Texas Republican Governor Greg Abbott bused 10,000 migrants to sanctuary cities across the country,

As a community, Iowa City is strong and prepared to do whatever it takes to help those in need. Organizations like the Catholic Worker House are preparing to help migrants settle into Iowa City in the event that Abbott sends a bus of migrants or if any migrants relocate to Iowa City from a different sanctuary city.

Abbott does not want to send migrants to sanctuary cities because he wants them to live safe, decent lives. He does it because he wants to overwhelm sanctuary cities and punish them for being empathetic.

Ultimately, we should ac­cept migrants bused from Texas because they deserve to be treated like humans. Abbott is determined to use them as political pawns to prove a point, but we must take the high road and prove that we will always choose empathy over meaningless political gains.

Iowa City is a compassion­ate, accepting city, and we should always be prepared to provide for those in need.

A former guy changed the American dream

Trump is a detriment to this country

Echo opinion published in the Billings Gazette:

Indeed, a couple of years ago, a Former Guy president was a clear and present danger detriment to America, and we are not the same nation as in the past.

There is a lot of turmoil and I’ve never seen such divisive friction as what we now have in America. There are politicians who are afraid to speak out as to how they feel, and to the contrary there are others who are too demanding and belligerent.

Some politicians profess that building a wall to keep out immigrants is the answer. The immigrants are struggling to enter this country to escape hardships, oppression, and to seek peace.

Protect America's immigrants! 

Robert Flanagan in Billings, Montana

Asylum- We did not choose where we were born: Nor did they

A Texas opinion published in The Monitor - Let’s be rational on immigration

What should we think about immigration? It’s complicated. Are there some who might be criminals? Research shows, it’s very few.

Far more likely, the following describes who’s coming. People avoiding extreme violence, persecution, starvation and more.

These are the people at the border. They are seeking safety. Seeking life. Seeking asylum. Coming to a border where the law, both U.S. law and international law, guarantees them the right to cross over, to ask for asylum and to stay while their stories are verified.

But it’s not happening. Our young parents, our farmers, are greeted by a high fence and tear gas. We did not choose where we were born. Nor did they.

Some are seeking asylum. 

U.S. laws and a treaty we have signed requires the U.S. attorney general to grant asylum if an individual has suffered persecution or has a well-founded fear of future persecution based on “race, religion, nationality, membership in a particular social group, or political opinion.”

People don’t uproot their lives and set out for distant lands for trivial reasons. Our ancestors did not. We need a comprehensive immigration policy that will protect our borders from criminals, but one that will also grant to those who are fleeing terrible conditions the same privilege that our ancestors were granted, the privilege of contributing to our society by hard work, and by bringing their food, traditional dress and their arts that will further enrich the lives of us who are already here.

Let’s demand that our politicians compromise and settle on a rational and humane policy for immigration.

From- Virginia Gelineau, Palmview Texas

Tennessee echo opinions about the stupid and expensive Trumpzi border wall

Donald Trump claimed that the border wall would be covered in solar panels, “see-through,” anywhere from 30 to 65 feet tall, or any one of the ugly, useless and expensive prototypes he commissioned. But judging from the latest iteration of the stupid project, there is every indication that it was slapped together at the last minute using a gradient and Windows XP clip art. Crazy Trump is increasingly desperate to just get anything up that he can take a photo op with as soon as possible. Enter the “Steel Slat Barrier,” which is not a wall per se but a series of upright metal strips terminating in spikes, says Gizmoto's Tim McKay.

Make the stupid wall issue easy, says Tennessee- just invade Mexico and wall off Canada!

The ugly, ineffective, stupid and expensive useless Trump border wall

Much is being said about building a wall between us and Mexico. Donald Trump promised he would get Mexico to pay for it. 

Well he can: Let’s invade them — again. Remember the Mexican-American War, 1846-1848? That’s how we got (after annexing Texas) Arizona, New Mexico, California, Utah and Nevada.

We may not have money for a wall, but we always have money for war. We take 10 miles from Mexico all across the border, put the POWs and refugees on old buses and send them south, and then burn everything. This will bring the Mexican army to meet our Army, creating a no-man’s-land. This free-fire zone will, effectively, be a wall.

Once this is done, we can look to our northern border and those pesky Canadians. Does anybody really know what they are doing up there? They have been undermining our currency for years with their Canadian quarters and nickels. Let’s put a stop to it with another wall. The northern wall would have to be pretty tall to keep those lumberjacks from building siege devices and trebuchets to unload bags of Canadian coins into our country. It will also stop those Sasquatches from freely roaming back and forth.

After that, let’s put a wall around Alaska to keep the Canadians and the Soviets from migrating. Remember the land bridge? It could come back.

A wall around the eastern coast is a no-brainer with the raft people and drug runners coming ashore at all hours of the day and night. For total wall security, the west coast will need a wall to keep seapeople from seeking a better life in this country.

The only thing that could go wrong with the Mexican invasion is what would we do if they surrendered?

John F. Youhouse, Clarksville

Tennessee echo opinion published in the Leaf Chronicle

Border wall won't help, it will only harm America

"The border wall is not only a waste of money, it will be largely ineffective. Most immigrants are “overstayers,” so they arrive in the country via legal means."

The wall will do nothing to stop this.

Another problem with the wall is that it will destroy the habitats of several endangered species as well as Native American historical sites. We have already destroyed enough of both of those things; we cannot allow it to continue.

This is not the way to put "America first." It will ruin so much of America that is already wonderful, removing important sites from our future generations.

Kasey Boatwright, Clarksville

Stupid Border Wall: echo from Mississippi with a history lesson

A stupid Border Wall is an ancient idea- An opinion letter from Moss Point*, Mississippi, echo published in the Sun Herald, a Mississippi newspaper.  

General George Patton quotes:  Fixed fortifications are a monument to the stupidity of man.
Quoted in 50 Military Leaders Who Changed the World‎ (2007) by William Weir, p. 173
Unsourced variant: Fixed fortifications are a monument to the stupidity of man. Anything built by man, can be destroyed by him.

In my opinion, a border wall will be a target for sabotage.  Besides, you don't need to be a four star general to realize how the Vietnamese built tunnels in their strategy to defeat the Americans in the Vietnam war....

Dear Editor:  General George S. Patton said, "Fixed fortifications are a monument to the stupidity of man."

The justification for building a wall at the US southern border based on walls that were built during ancient times is absurd. A wall is a 16th century solution for a 21st century problem.

The facts show, a majority of illegal immigrants come into the U.S. from overstayed visas. The majority of drugs come in through open posts of entry, and some through an array of tunnels. Apprehensions of illegal aliens ar our southern border are at historic lows, down from a high of 220,000 a mont in 2000 to 40,000 a month in 2019.

People would have you believe 4,000 suspected terrorists have been apprehended at our southern border, but the actualy nuber is 6 (six!), the other 3, 994 were detained at airports, worldwide. These people are being wrongly portrayed as being criminals, murderers and thieves, out to crate crime in our streets. 

Yet, studies prove that the overwhelming majority of illegal immigrants living in America commit less crime than the general population. These people are just poor souls, looking for a better life, running from poverty and/or certain death from corruption and crime in their native countries.

The majority of illegal immigrant refugees now come from Central American Northern Triangle area. That's not to way we should have open borders, we don't. Yes, we need to account for everybody entering our country but we need to be smart about it, cost effective and humane, and not waste upward of $30 billion dollars for ancient walls.

From David Cameron, Moss Point Mississippi

*Post Script from Maine Writer- I looked up "Moss Point", a practice I try to do before publishing "echoes", to verify locations of the authors. I discovered that this location in Mississippi was devastated by hurricane Katrina. Therefore, I'd say, border walls are not only stupid, ancient and subject to destruction, but also at risk for the destruction caused by natural disasters.

Moss Point is a city in Jackson County, Mississippi, United States. The population was 13,704 at the 2010 census, down from 17,653 at the 2000 census. On August 29, 2005, Moss Point was hit by the strong east side of Hurricane Katrina, and much of the city was flooded or destroyed.Wikipedia

Echo from the Texas border that Mexico was going to pay for: Another local voice

Immigration reform will work better than a border wall: An echo opinion letter published in the Texas, El Paso Times.

This photograph and hundreds like it are the evil legacy of Donald Trump's border wall that "Mexico would pay for".  He said to his cult followers, "Who will pay for the wall?  Who?" Putting people in cages is a humanitarian degradation attributed to the Trumpzi cultists and their unfounded hysteria about how innocent immigrants are somehow capable of bringing crime into the US.  Mexico will never pay for an evil wall but Donald Trump has created heinous human cages, instead.  

Over the past 10 years, violent crime rates have not changed in El Paso because of the border wall; however, other minor crimes have decreased thanks to task forces initiated by the El Paso Police Department. Since 2000, undocumented immigration has decreased by 20 percent while the vast majority of drugs entering this country has been through ports of entry. 

Building a wall won’t stop individuals from trying to cross undocumented, won’t deter crime from happening on the Mexican side of the border, and won’t stop drugs from entering our country.

Rather than addressing the root cause of our problems, Donald Trump’s turned to declaring a national emergency to build a wall that he hopes will stop undocumented immigrants and drugs from entering our country. Trump’s wall will not prove to be successful; therefore, I believe a more successful approach is reforming our existing immigration policies and increasing the number of officers at our ports of entry to stop drugs from entering. 

If we spent the billions of dollars for the proposed wall on revising our immigration policies and adding more technology and agents at our ports of entry then we might see a decrease in our country’s opioid and drug epidemic as well as undocumented immigrants who risk their lives to live the “American Dream.”

Sylvia Garcia  

Anthony, Texas

Echo opinion letter from Scranton PA ~ racist Donald trump

Donald Trump exceeded limits of tolerance

Letter to the editor echo: 

The Times Tribune in Scranton Pennsylvania

How much longer do we have to tolerate a pathological liar, womanizer and philanderer occupying the White House Oval Office?

Donald Trump has done nothing but obstruct justice since he took office. He also is definitely a racist. 

Moreover, Donald Trump wants to pick and choose who can come to this country and make decisions that would affect the lives of even those who have lived here for years.

He refers to immigrants as “animals.” If that isn’t racist, I don’t know what is. There are many racists in this country and many of (wrong minded people) seem to love him.

The stench of corruption coming out of the swamp in Washington, D.C., is overpowering. Members of the Republican Party, that bow down to him despite his despicable behavior,

If a Democrat had ever done what Donald Trump has done so far, the (hypocritcal) Republicans would have made sure he was thrown out of office.

What has happened to our great nation? If voters want to really "Make America greater". Get rid of Donald Trump. Vote him out of office.  From Tom Hughes, Covington Township

Human Trafficking: A tragic public safety issue- victims need care

Nurses are considered mandatory reporters for suspected minor age (under 18) human trafficking victims.

"....and a crime against humanity..." Cheryl Green MSN, RN, CNL

"...many victims suffer from chronic untreated diseases, such as tuberculosis, diabetes or asthma, as well as infestations, poor dentition, dehydration, and malnutrition."

"Victims who are immigrants were probably told that authority figures are the enemy and will seek to arrest or deport them."

Although Republicans are obstinately resistant to progressive changes in the US immigration laws, the facts are accumulating to show how human trafficking is becoming a public safety issue and even tangentially related to illegal immigration, because victims often feel like they're criminals. In fact, while illegal immigrants are worried about being deported, the victims of human traffiking are frightened, because they must hide in the shadows or face criminal charges, plus deportation. Moreover, many of them are physically and emotionally ill, suffer from post-traumatic stress disorder and are victims of domestic violence.

A nurse may be a victim's only point of contact outside of captivity. It's mandatory for nurses to report human trafficking of minor age children.

In other words, human trafficking is the darkest side of the illegal immigration issue. Worse, it's unlikely the trafficking will stop, just because immigration reform happnes to be resolved.

Public health is at risk for infectious diseases with this growing trafficking problem, because the victims of are usually living in poverty, or worse, and not receiving the benefit of medical care. They're a lost population. 

In the magazine, American Nurse Today, an article by Cheryl Green, MSN, RN, CNL, defines the human trafficking issues.
She calls it a "crime against humanity". 

IN MOST WAYS, human trafficking (modern slavery) is no different from slavery of ancient times: it's brutal, highly profitable business with  no regard for its victims. Trafficking is a crime but it's often difficult for medical providers to recognize the victims and to identify how to help them.

Human trafficking falls into two broad categories:
1.  Labor trafficking- typically is either forced hard labor, usually in agriculture or textile sweatshops; or domestic labor, such as working as a nanny or house servant.
2.  Sex trafficking - involves forced work in strip clubs, massage parlors, pornography production or prostituion. It also may involved  mail-order brides.  

"Human trafficking: Preparing for a unique patient population", by Green describes the most prevalent form of slavery in the United States being "sex trafficking". 

An estimated 14, 500 to 17,500 people are trafficked into the US annually and 100,000 to 200,000 American minors are exploited in the sex industry. Worlwide, 2 million children and young women are trapped in sex slavery.  

Consequences for the victims 
Human trafficking victims face grave physical and emotional dangers every day. Research suggests initial gang rape is a common method of recruitment into slavery. Threats of repeated rape, if the victim doesn't comply with demands, are common.  Some victims rescued from the sex trade report customers who didn't like condoms and paid extra to avoid using them.  This puts victims at great risk for sexually transmitted infections, unplanned pregnancy and physical trauma from rape.

Physical abuse, rampant in the trafficking business, is a primary means of forcing victims to comply. A study of European trafficking victims found about 75 percent were kicked, punched in the face, burned with cigarettes, hit with objects, dragged by their hair or struck in the head. More than half had post-traumatic stress (PTSD) disorder. Also, many victims then abuse or become addicted to the drugs or alcohol, given to them by their traffickers (sometimes by force) to control them. What's more, many victims suffer from chronic untreated diseases, such as tuberculosis, diabetes or asthma, as well as infestations, poor dentition, dehydration, and malnutrition.

These facts underscore the immediate and imperative need for healthcare advocacy for victims. Unfortunately, caregivers, nurses, the public at large or public safety professionals may have limited knowledge about how to identify victims of human trafficking, especially in the healthcare setting.

Helping to rescue victims
A nurse may be the trafficking victims only point of contact with the environment outside of captivity. To help rescue victims from a horrific life they didn't choose, healthcare providers need to become knowledgeable about this crime against humanity.

Implications for nurses
In 2014, Katherien Chon, senior adviser on Trafficking in Persons, for the US Dept. of Health and Human Services, testified before Congress that roughly 75 percent of trafficked women saw a healthcare provider while they were in captivity. In most cases, this provider was in an emergency department (ED). Indeed, they are obviously seen in the most expensive emergent care setting without opportunity for follow up or access to primary preventive care.

Nevertheless, many trafficking victims can be identified in other settings where health clinics, acute-care hospital units, dental offices and jails.  This encounter may be a victim's only possible entry point into the social safety nets, yet many many trafficking victims aren't identified as such in healthcare settings. Once this opportunity to identify them is lost, it may never arise again, because traffickers typically don't allow visits to care providers unless a victim's health is so precarious that she or he can't work.

Even victims who seek care may go unrecognized or be mistaken for domestic violence victims, drug addicts or prostitutes.  

Failure to identify a trafficking victim in a health care facility can lead to tragic consequences or even death for that person.  

Nurses are front line caregivers and therefore have the opportunity to identify victims and refer them to appropriate resources.

Recognizing trafficking victims
Although human trafficking and domestic violence victims share some common presentations, important differences exist. For example, domestic violence victims usually fear one abuser, whereas trafficking victims may fear many people because they may have multiple abusers.  (If a victim is assessed for having poorly healed fractures or signs of repeated strains, this is an assessment for trafficking....)

Victims who are immigrants probably have been told that authority figures are the enemy and will seek to arrest or deport them.

Consequently, they may fear a uniform, including a nurses uniform. Also, trafficking victims tend to be more isolated than domestic violence victims, to suffer disease or malnutrition and to have little or no family contact. Also, they're more likely to be victims of substance abuse.  

Some victims, although cognitively intact, may be unable to verbalize their current location, if asked. This is especially true of those trafficked into the United State from other countries. Not only are the victims in unfamiliar surroundings, but they may see little of their outside world and may not even know where they are.

Be aware that adults and children who've been coerced into prostitution in the United States aren't (not!) considered criminals. On the contrary, they're victims of human trafficking and protected under the federal Trafficking Victims Protection Act. 

In fact, persons younger than age 18 who are involved in commercial sex exploitation fall into the legal criteria for minor sex trafficking, their traffickers are prosecutable under the law. Nurses are considered mandatory reporters for suspected minor (under 18) human trafficking victims.

Approaching a suspected victim
If you suspect a person or patient of yours is a trafficking victim, consider how to best approach him or her. Never ask outright if she or he is a trafficking victim, especially if a companion is present. Most victims probably don't know what the term "trafficking" means. What's more, few people, no matter how dire their circumstances, want to be called a victim, because they're trying to retain as much dignity as possible. 

If a patient doesn't speak English, call for a medical interpreter.
Be prepared for the companion to insist that he or she can interpret, but decline this offer, explaining that facility policy allows only for certified medical interpreters. Also, consider cultural factors. For example, female victims from patriarchal cultures typically are unwilling to speak for themselves, the same, of course, for minors.

Anticipate that victims will resist help. Feelings of intense fear, shame, and helplessness may even compel some to try to leave the facility without treatment. In some cases, a companion who senses that authorities suspect the true nature of the situation may force the victim to leave. Therefore, if you suspect trafficking, make sure a staff member stays with the victim at all times. (In fact, one way to assess the risk of a person being a trafficking victim is the sense that he or she is under surveillance, at all times.)  Keep in mind, of course, that many immigrants and other foreigners can't read, write or speak Englsh and are accompanied to the hospital by companions who speak for them, yet are not trafficking victims. Consequently, be careful not to base a trafficking assessment solely on these characteristics -  but diligence to the issue will alert the nurse to any unusual interacton or situation.

Human trafficking victims don't receive preventive helth care, so by the time emergency or clinic providers encounter them, many health conditions may have become serious and vcitims may be in dire health circumstances. With this in mind, conduct a head-to-toe nursing assessment, providing as much privacy & comfort as possible.  

Asking certain questions can help determine if the patient is a trafficking victim, without causing fear or alienation.

Be aware that repeated violent penetration may  cause vaginal or anal fistulas. Even young women may have bowel or bladder incontinence, or both.  Many trafficking victims have positive drug screens, infectious diseases, live or scabies infestations or tattoos with brands of gang symbols, trafficker initials or even barcodes.


Psycho-social issues are prevalent among this population. Although victims may have pronounced anxiety or panic, some may even be stoic, almost to the point of complete withdrawal.

Finally, lack of trust may lead victims to suspect you're trying to trap them into revealing information as a test of loyalty to the trffficker, putting the victim, or the victims's family, in danger. Establishing trust is difficult but crucial (!) because the trafficker most likely is the only person the victim feels they can trust and rely on.

Cheryl Green is a cardiac/medical-surgical nurse at Cone Health Alamance Regional Medical Center in Burlington, North Carolina.

The National Human Trafficking Resource Center is a resource for more information:  1-888-373-7888,  Consider posting the phone number where patients can see it.

Staten Island Ferry Voters

Riding the Staten Island Ferry in New York City's Harbor is a beautiful way to view the Manhattan skyline and The Statue of Liberty. Sailing on board the ferry is also like being in a mini-United Nations.

Families of all "types and stripes" use the ferry for the 5 mile transport between Manhattan and Staten Island.  These families, many with young children in strollers, speak in their vernacular languages while passing time waiting in lines and sailing New York Harbor. While riding the ferry recently during several crossings, I listened to identify languages like Spanish, French, Slavic languages (perhaps Polish), Chinese, other than American accented English (Irish?), Indi (or Tamil), different Asian languages, Tagalog and various American English accents.

Let's just suppose we created a voting district called The Staten Island Ferry.  We're talking about 20 million people a year or 60,000 people a day, says the website.  So, for the sake of creating a voting district, let's say our Staten Island Ferry District includes people on only one crossing.

Based on my observation, I'd say the ferry boats I rode included about five hundred people each crossing, speaking at least six different languages that I could identify, not including American regional English accents.

Again, based on my observations, it's impossible for me to believe the microcosm of America's melting pot represented on the Staten Island Ferry would choose to vote for candidates with right wing extremist views. Although this is only my observed opinion, the families I saw do not look like the type of people who would support a president who raised the rhetorical specter of illegality towards hard working immigrants, like Rick Perry, Sarah Palin, Michele Bachman, Rick Santorum, Ron Paul or their followers.

During my observation, I imagined how the Staten Island Ferry riders, while sailing past our amazing gift from France, the beautiful Statue of Liberty, each time they rode, must reflect, as I did, about why they are in New York City, in the first place.

My Italian grandparents made it possible for me to be visiting New York City.  I recall my grandmother, Alessandra Dini telling our family what it meant to see The Statue of Liberty when she and her husband, Eugenio Anselmi, arrived from Italy. She cried while telling the story, in broken English, over and over again.

Millions of other ferry riders could each tell their own compelling stories.

Which is why I simply cannot fathom how the Republican Right Wing Establishment can preach against immigrants. Their own ancestors were among those who saw Lady Liberty in New York Harbor, along with my grandparents.

Although RWE-RWEs (rightwingextremists) use the word "illegals" as a euphemism for their extremist views when referring to immigration, by inference, their labels impugn all immigrants, including my grandparents.

Riding the Staten Island Ferry was an amazingly peaceful experience.  I suspect many of the families who enjoyed the 25 minute ride could tell horror stories about their home countries where people simply don't get along.  It's a miracle to see how all of these diverse populations sit side by side in quiet comfort while riding the Staten Island Ferry.

Prayerfully, I hope this microcosm of America's heritage might flood our patriotic immigrant pride.

Politicians who rail against immigration would never want to hold their election in my Staten Island Ferry voting district.