Written by Carolyn Reardon, a first year medical student and participant in the Local Global Health Elective coordinated by the Global Health Office at Dalhousie University.

As part of the Local Global Health Elective, I recently spent six weeks tagging along with “Rick the Nurse” and the Mobile Outreach Street Health initiative, or MOSH, a converted minivan that has been equipped to bring basic medical services to populations in Halifax that traditionally have had difficulty accessing mainstream health care.

One of the key aspects of MOSH that’s resonated with me throughout my short time riding along is the collaborative nature of the operation. One afternoon we stopped at the ‘Treehouse’, a boarding house for men in south end Halifax, not for a clinical appointment, but rather to check in with a patient who had a meeting with housing services the next day about transitioning to more permanent housing. Out front on the sidewalk, Rick reviewed the schedule for the following morning with the patient- a Health Navigator was to pick him up around 10am- and handed him bus tickets to get back home.

In this way, I’ve been moved at how above and beyond the MOSH staff go in caring for their patients. On one occasion, Rick agreed to hold on to some of an HIV positive patient’s antiretroviral medication for safe keeping while the patient faced possible incarceration for the next several months. Time and again, acts such as these have taught me the importance of relationship building and trust in delivering effective health care. I’ve been continually impressed and inspired by MOSH’s non-judgmental attitude and adaptable approach in delivering their services- staff often communicate with patients via text message, and for patients without cell phones, they leave messages with shelter staff. I’ve seen the benefits of this flexibility in action, in that patients feel comfortable approaching the van with sensitive issues. MOSH will meet patients where they are, whether it’s their home, a shelter, a local soup kitchen, or the back of the van.

Spending these weeks with MOSH has opened my eyes to how pervasive poverty is in Halifax, and at times is invisible to the naked eye. For example, I was shocked to learn that Hope Cottage feeds up to 150 people a night. Although MOSH operates out of the North End Community Health Centre, the van travels all over the city and throughout Dartmouth. It’s exposed me to how difficult the cycles of poverty and addiction can be to break within families. My first afternoon with MOSH, we were tending to a wound a middle aged man had acquired from injecting Dilaudid, a narcotic pain reliever. The patient mentioned that when he has difficulty seeing his veins from years of injecting, his son injects the drugs for him. It’s been startling to me how extremely common prescription drug addictions are in Halifax. Although I’m born and raised in this city, these issues were completely foreign to me.

While the majority of the patients MOSH sees have no fixed address, I experienced a true sense of community during my elective. Countless times on our visits to Metro Turning Point, a men’s shelter in the North End, residents approach us and indicate another resident is in need of medical care, saying, “Make sure you see so-and-so before you go.” Many times patients mentioned they were referred by someone else who utilized MOSH’s services. These experiences have inspired me to continue volunteering with MOSH now that my elective has come to an end. Although my final destination in medicine is undetermined, I hope to carry with me the flexibility, adaptability and accessibility I’ve learned to value throughout my time with MOSH that will surely serve me in whatever specialty I end up practicing, and for this I will always be grateful.