Sarah never thought she would end up trapped in a modern slavery situation.
Six years ago, she escaped from debt bondage after meeting a man who promised to help her set up a business.
Debt bondage is a form of modern slavery whereby a person is forced to work or pay off a real or fabricated debt.
According to the federal government's website on modern slavery in Australia, the employer or recruiter might keep adding to the debt making it impossible to ever repay.
"In the time I was being exploited, I would end up in emergency departments, sexual health clinics, GP offices," Sarah said.
"But they weren't really able to understand what was happening to me and I wasn't able to tell them because I didn't have the right words and didn't feel safe enough to talk."
Sarah, who asked to only be identified by her first name, has used her lived experience to help inform a new guide for healthcare workers to identify and respond to signs of modern slavery.
It was launched earlier this month in Dubbo.
The resource was designed by experts and people with lived experience of modern slavery. (ABC Western Plains: Lily Plass )
NSW Anti-slavery Commissioner James Cockayne said the bindings of modern slavery were often invisible to the untrained eye.
"These days it's not physical shackles that are used to restrain people," he said.
"It's manipulation, coercion, often under the cover of a contract."
More than a social issue
The booklet is not a mandatory reporting policy, but it teaches healthcare professionals how to ask trauma-informed questions and where to turn to if they believe a person is being victimised.
The Royal Australian College of General Practitioners (RACGP) made a submission to help inform the tools in the guide.
Jennifer Neil, deputy chair of the RACGP's Specific Interest Group in Abuse and Violence in Families, said modern slavery was a health issue as much as a social issue.
"It causes significant health problems that can cause, obviously, injuries …" she said.
"But also mental health problems and chronic psychosomatic problems, such as chronic pain."
Dr Neil said GPs were well placed to recognise signs of modern slavery because they came into repeated contact with the patients over time and could identify patterns.
The guide includes signs healthcare workers can look out for such as another person inserting themselves into the patient's care, or the patient referencing ongoing debt or repayment obligations.
Sarah was able to escape from modern slavery six years ago. (Supplied: Office of the NSW Anti-slavery Commissioner )
Sarah said people trapped in modern slavery might not grasp the severity of their situation, which could make direct questions confronting.
Instead, the focus should be on simpler questions and building a relationship.
"I think if I had the opportunity to talk to a healthcare professional that could have pointed me in the direction of modern slavery services or helped me to understand my situation or given me access to the right support, it could have prevented a lot of harm and long-term impacts for me," Sarah said.
Trust in doctors and nurses
Dr Cockayne said victim-survivors often turned to healthcare professionals rather than speaking to law enforcement.
"[Healthcare workers] are more focused on our needs rather than necessarily judging our behaviours or judging us for the situation we find ourselves in.
"It's creating that kind of relationship between the healthcare worker and the patient that creates an opportunity for the disclosure of that kind of abuse."
Healthcare workers such as doctors and nurses have been identified as potentially trusted places. (ABC)
Dr Neil said she hoped as many healthcare workers as possible became aware of the available resources to recognise modern slavery.
"I think disseminating this amongst healthcare workers is going to be one of the biggest challenges," she said.
"Actually letting people know it exists and getting people to have a look at it and read it."
A 'football stadium' of people trapped
According to the NSW Office of the Anti-slavery Commissioner, it is estimated that about 16,400 people are trapped in these invisible bindings, with the national number believed to be about 41,000.
The resource is expected to be rolled out soon at locations across the state. (Supplied: Office of the NSW Anti-Slavery Commissioner )
"That's a football stadium of people who are in this situation right now," Dr Cockayne said.
"This resource was developed for the NSW context, but we see no reason why it can't be used elsewhere as well."
Sarah said she hoped the guide would make it easier for the next person to break free.
"I think we all have this perception that we're a person, we have choices, we have freedom," she said.
"But when that's taken all of a sudden, that really challenges everything about the way that you see the world."
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