Medicine runs in Santhosh Paulus, MD, and his family. His grandfather and brother are physicians while his mother is a nurse. Growing up surrounded by healthcare professionals, a career in medicine felt less like a choice and more like a calling.
He chose family medicine for its breadth. The opportunity, as Dr. Paulus describes it, to provide care "from the cradle to the grave." Early in his career, he found his greatest satisfaction not in treating disease, but in getting upstream of it.
Watching patients experience the devastating complications of uncontrolled diabetes—stroke, amputations, dialysis—motivated him to focus on prevention, reaching patients before the well-known disease process unfolded and affected not only them, but the generations that would follow.
"I envisioned my career to continue along this path involving direct patient care and in graduate medical education," said Dr. Paulus, senior program director for the Human Trafficking Education, Advocacy, Response and Training Program at Northwell Health.
He could not have anticipated where that path would lead.
Northwell Health is the largest not-for-profit health system in the Northeast, serving residents of New York and Connecticut. It is part of the AMA Health System Member Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
A conference that changed everything
In 2017, Dr. Paulus attended a national conference through the American Academy of Family Practice. At the time he was serving as associate program director for the Glen Cove Family Medicine Residency Program at Northwell Health. One session stopped him in his tracks.
Ronald Chambers, MD, a family medicine program director, described the Medical Safe Haven he had created for survivors of human trafficking at Dignity Health, now CommonSpirit Health. He shared cases where patients presented with vague histories that did not quite match their physical findings or fit neatly into a timeline.
As Dr. Chambers spoke, Dr. Paulus began thinking about a patient of his own. A patient who kept returning to clinic, complaining of generalized abdominal pain, with a workup that turned up nothing. At the time, he had approached it as a clinical puzzle, ruling out causes with imaging and cultures, working within the constraints of a packed schedule where the pressure to keep moving was constant.
“I started to recall other patients where I felt that I could have listened a little better to what they were telling me”, said Dr. Paulus. “I had missed opportunities to help patients who were asking for help in their own way.”
The realization was not one of self-reproach, but of possibility.
“After hearing Dr. Chambers share his patient encounters, I knew I wanted to do better as a physician,” he said, “but also to make other physicians aware of this valuable and untapped area of knowledge regarding an often misdiagnosed and misunderstood patient population."
That session marked the beginning of a mentorship with Dr. Chambers and the start of an entirely new chapter in Dr. Paulus's career.
His epiphany led to the creation of the first Northwell Health Human Trafficking Response Program at Huntington Hospital in New York, a program that has trained more than 27,000 caregivers and almost 800 in person with close to 30 identifications. As well as over 500 community members trained, such as school superintendents and PTA representatives.
Getting upstream of a different kind of problem
Before Dr. Paulus ever proposed a hospital program, he and his wife Rajdeep were already doing something about these vulnerable patients. In 2015, he created Cycling for Change, a nonprofit dedicated to raising funds and awareness to fight human trafficking and amplify the voices of survivors.
Through his work with communities on Long Island and during a cross-country cycling tour, he saw the power of what happens when communities come together to address human trafficking. The experience gave him the confidence to extend his influence as a family medicine physician and start asking how healthcare was responding to this public health issue.
How was it supporting people who had experienced trauma and violence? Or reaching those on the margins of society who are most vulnerable?
“When you ask questions about what is being done to address issues or problems, you have to be prepared to be a part of the solution,” Dr. Paulus said.
Human trafficking, Dr. Paulus came to understand, is a social justice and human rights issue of this generation—one that demands a coordinated response across disciplines.
"When trafficking victims come through the healthcare system, but we don't identify them, it's a big, missed opportunity," he said, noting that "being the father of four girls has put all this in perspective for me."
Start where relationships exist
When Dr. Paulus proposed creating a human trafficking task force, he chose Huntington Hospital in Suffolk County—not because it was the obvious starting point, but because it was where he worked clinically, where his team was most connected, and where he had relationships.
The task force began as a group of about a dozen Huntington Hospital employees from several departments, trained to identify and assist human trafficking victims, provide healthcare to survivors, and connect them to community organizations. Some of those original members had doubted that human trafficking was even an issue in the Huntington area. That skepticism did not last long.
Dr. Paulus decided to partner with Restore NYC, a community-based organization that serves people who have been trafficked in New York City. Together, they co-developed training and educational sessions to help healthcare professionals recognize red flags and identify people who had been trafficked or were at risk of being trafficked. All of this took place through a trauma-informed, survivor-centered lens.
Within months of launch, the team had identified five human trafficking victims who had come to the hospital. Data from the National Human Trafficking Hotline confirmed what the community already knew: Suffolk County had twice the national average of calls related to labor trafficking in the 10-year period prior to the program's start.
Several months after launching the program, the groups hosted a human trafficking symposium that brought together community-based organizations, law enforcement, the criminal justice system, survivors and healthcare professionals to learn from one another. The message from community leaders was consistent and striking.
"They had been waiting for healthcare to show up," Dr. Paulus said. "They felt we were the missing piece in a comprehensive, multidisciplinary response."
Dr. Paulus and his team also connected with organizations such as the Empowerment Collaborative of Long Island to ensure survivors had access to the resources they needed and joined the Suffolk County Anti-Trafficking Initiative and the board of ECPAT-USA, a nonprofit focused on the commercial sexual exploitation of children.
Build survivors into the response
The initial pilot program at Huntington Hospital grew into a larger system initiative, the Human Trafficking Response Program, and eventually the H.E.A.R.T. for Human Trafficking Program—Human Trafficking Education, Advocacy, Response and Training. Growth was possible because senior leadership at Northwell recognized that human trafficking was a real issue affecting people across the health system and in its communities.
That commitment remains a guiding principle across Northwell Health, said Debbie Salas-Lopez, MD, MPH, executive vice president of Community & Population Health and Institute for Community Health & Wellness.
“One of the best things we can do, no matter what our situation and circumstances, is to pay it forward,” Dr. Salas-Lopez said. “Northwell Health stands and will always be committed to this work because it is so important for our vulnerable communities.”
Today, the program provides both inpatient and outpatient care, in the emergency department and in urgent care, and longitudinally through behavioral and medical services. Dr. Paulus's current areas of focus include expanding access to behavioral health services, increasing availability of dermatologic services for patients seeking tattoo removal, and developing survivor job placement and mentorship opportunities. Longer-term plans include growing school education programs, expanding regional and international symposiums, and working toward becoming a medical safe haven for victims of human trafficking and those at risk.
Along the way, Dr. Paulus learned lessons that no medical training had prepared him for. Chief among them: To solve a problem, you must first get close to it.
"We need to get proximal to the problem and get close to those who are survivors and those with living experience," he said, using the term he recently learned from a survivor who noted that "lived experience" understates the ongoing nature of trauma.
"It's not something they just get over,” Dr. Paulus added. “It is a continual process."
When developing policies and protocols to identify, treat and refer people who have experienced violence and trauma, those individuals—and the community organizations that support them—must be involved from the very beginning. Not simply present, but actively shaping the brainstorming, development and implementation, and continuing to be engaged as programs are evaluated and refined.
"Part of leadership is advocating on behalf of those who are best suited to bringing solutions," Dr. Paulus said, "and ensuring that their voices and ideas are heard and incorporated into the policies created."
Replace rescue with trust
Helping does not always mean rescuing. One of the core principles of trauma-informed care is respecting a patient's choices—even when the person does not disclose trafficking or immediately accept help.
Traffickers exert power and control by taking away choices. Health professionals, even well-intentioned ones, must be careful not to replicate that dynamic.
“We can’t force a patient to put the cigarette or vape pen down. It would no longer be their choice,” said Dr. Paulus, drawing a parallel to a patient who smokes but isn't ready to quit.
Unless there's an immediate risk of death or serious harm to the patient or others, you have to respect a patient's decisions.
“If a patient denies victimization or declines assistance, it is imperative that we respect the wishes of the patient,” he said. “If we have concerns about the patient’s safety, we can offer them resources to a hotline or other emergency services.”
Dr. Paulus recalled one patient in labor and delivery who denied being trafficked. The team responded in a nonjudgmental way, providing general education and shared resources by normalizing the information. For example, saying, “We share this with all patients,” or “If you have a friend experiencing X, Y, Z, here are resources they could use.”
The patient returned a month later and disclosed they were being trafficked. They explained they first needed to get their children to a safe place before seeking help.
“They felt safe to return because of the rapport that the staff had made,” Dr. Paulus said. "They felt they could trust that the team was there to help them."
This process is all about taking “the cape off of our backs and not think that we are rescuing individuals,” he continued.
The role of physicians and other clinicians is to educate and empower individuals by building trust, providing information about violence and connecting them with resources. Those are the core principles of the PEARR Tool, a trauma-informed approach to victim assistance in healthcare settings, designed in partnership with HEAL Trafficking, Pacific Survivor Center and CommonSpirit Health.
e it our aim to have trauma informed and survivor-centered practices and programs,” Dr. Paulus emphasized.
Developing safe spaces requires thick skin
For physicians drawn to unconventional paths, Dr. Paulus offers practical and hard-won advice: Start by educating yourself. Look at what responses have already been attempted in your community and within healthcare systems in your region to understand what has worked, what has not and where the gaps remain. Build a coalition of people already working in this space. Talking with those most affected will help you ask the right questions and identify real solutions.
The response may begin with volunteering on committees, joining organizations or participating in task forces that are already addressing these issues. Seek out mentors in leadership positions who can help you navigate the murky waters of tackling problems that society and leaders may not always view as priorities.
“It is important to have a moral compass and thick skin when addressing issues that are not popular or revenue generating,” Dr. Paulus emphasized. Successful mission-driven programs often exist because they are the right thing to do, are sustainable financially, or because policies or laws require action.
“You need to figure out which approach or approaches would be strategic and be ready to pivot if things change,” he said.
When hope ignites change
Remaining humble and nonjudgmental, Dr. Paulus has found, is not just a professional virtue, it is a prerequisite for this work.
He returns often to the words of Bryan Stevenson, a death row lawyer and founder of the Equal Justice Initiative, “I don’t do what I do because I have to. I do what I do because I’m broken too.”
"These words humble me, motivate me, and remind me to approach others with less judgment and more of a shared human vulnerability," Dr. Paulus said. “When you recognize how much more alike we are than different, it becomes easier to connect with those who are marginalized and vulnerable—and to approach them with genuine humility.”
“Letting people know that you see them and hear them lets them know that they are not alone in their situation,” he said. “This simple act of kindness helps people to have hope despite their difficult circumstances.
“When communities come together to support one another and offer hope, that hope becomes a powerful spark that can ignite real change,” Dr. Paulus added.
The AMA encourages the education of physicians about human trafficking, including how to identify and report cases of suspected human trafficking to appropriate authorities, and how to address the victim's medical, legal and social needs.
Additionally, the AMA Code of Medical Ethics offers physicians’ guidance on their obligation to take appropriate action to help patients avert harm that violence and abuse cause.
