There are several possible indicators of these relationships. The occurrence of sexually transmitted infections, pregnancy, unsafe abortions, branding of the skin, or tattoos which the patient does not want can suggest an abusive relationship. There may be broken teeth or other dental problems which result from physical violence. They may suffer from malnutrition, injuries, sleep deprivation, heart disease, and back problems .
Health care workers, therefore, must consider these presentations as a sign that the client is in an abusive situation. In fact, the medical provider may be the first person to detect and report it to legal authorities . This applies to any patient who comes to a health care facility for a routine physical examination, gynecologic evaluation, prenatal care, or medical emergency.
It is especially suspicious when the patient or someone else pays with cash for the medical visit. This enables the agent to conceal identity or movement of the victim which checks or credit cards will reveal. In many instances, the workers have to frequently change addresses so that members of the community do not have enough time to notice that there is something odd about the situation .
These arrangements will, of course, lead to a variety of mental health issues such as depression, anxiety, flat affect, feelings of helplessness, culture shock, shame, posttraumatic stress disorder, psychosomatic conditions, and suicidal thoughts or attempts. Should the person leave the situation, he or she may be left in a country where they are not citizens and become refugees [1, 2].