Mobile Outreach Street Health – An Interview with Becky Marval

March 29, 2016 Maria Wilson Leave a Comment

The MOSH van, which acts as a mobile treatment centre for underserved populations in the HRM (Source: GHO Blog, 2012).

Mobile Outreach Street Health (MOSH) has provided accessible primary care services to several underserved populations in the Halifax area since 2009: those who are homeless, insecurely housed and street involved. You may recognize the MOSH van (pictured above), which travels around the community acting as a mobile treatment centre. The MOSH website provides a comprehensive overview of their relationship-based care model, as well as their weekly schedule. In order to learn more about this amazing community organization, we interviewed Becky Marval, who works as an occupational therapist (OT) with MOSH.

How large is the population you serve?

The number of individuals who stayed in a homeless shelter in the Halifax Regional Municipality was 1,973 in 2011 [1]. However, not all those that MOSH serves are homeless, and MOSH does not serve the entire homeless population. According to a 2011 North End Community Health Centre program evaluation, MOSH had an average of 350-400 encounters per month [2].

You work as part of an interdisciplinary team. What members are on that team, and why do you think an interdisciplinary approach is important?

The core team has two full-time nurses, along with a part-time OT (Becky), a few part-time family physicians and part-time “jack-of-all-trades” administrative support. There is also a Housing First branch at MOSH, consisting of team lead EJ Davis and four intensive case managers, with support from an OT and a mental health outreach nurse through a partnership with the Nova Scotia Health Authority.

There are lots of reasons an interdisciplinary/transdisciplinary approach is important. One would be that the folks we’re seeing have complex needs that require different perspectives as well as different personalities. Relationship-based care requires that we have many different options for people, necessitating differences in personalities and skills. We are also able to share and learn from each other because of these different approaches. A transdisciplinary team has overlap and shared responsibilities that aren’t anyone’s job in particular, like handing out food or bus tickets. We also don’t have a social worker on the team, so wherever the scope permits, we stretch our scope as long as it can be ethically stretched in order to help the people we serve in terms of resource navigation. Having an interdisciplinary team allows us to do our work in a more holistic fashion.

What types of services do you provide as an Occupational Therapist with MOSH?

The types of services I provide are pretty broad. Occupational therapy is focused on allowing individuals to perform their activities of daily living (ADLs), like helping them take care of themselves or their apartment, assisting with mobility and transport, coping with chronic disease (both physical and addictions), and helping them find work or schooling. The focus on occupation can also mean helping individuals to determine meaningful things to do with their time, and how to adapt despite various challenges.

As previously mentioned, the role has to be broad because our team doesn’t have other specialist like a social worker or recreation therapist. Another piece of this work is helping to change the environment so it meets the needs of people. This can involve anything from working toward policy changes, to education around common topics that can be troublesome for staff that are trying to help clients, to building a ramp with limited resources to improve accessibility. There are a couple recent MOSH initiatives that benefit the population in innovative ways. The first is matching people with donated bikes, helmets and locks to facilitate mobility. The other is our history project, where people are encouraged to tell their stories. This provides a bit of a diving board for people to see themselves as experts and share their wisdom.

Have you partnered with Dalhousie University before? If so, in what capacity?

We have an established partnership with Dalhousie Dentistry as part of another partnership with the North End Clinic. This involves a dental clinic a few days per week where dental students come and practice under supervision. MOSH constantly has Dalhousie students from a variety of backgrounds doing work and service placements. A lot of student projects look for real life problems and situations, and MOSH can provide them with the opportunity to conduct program evaluations and literature reviews.

What do you think describes an effective partnership?

Aspects that are helpful include communication and mutual regard (respect, trust and awareness of strengths and weaknesses). Things that are not helpful include territoriality, guarding/protection of resources, and only looking out for oneself. Partnerships require similar philosophies, or at least the ability to arrive at a common ground or purpose. Finally, partnerships need to make sense for the target population. With MOSH that means achieving effectiveness with limited resources.

What do you find most rewarding about your work with MOSH?

I find it really rewarding when I’m surprised at how well things can work out. I shouldn’t be surprised anymore, but just when I think we’ve run out of options, it’s very rewarding to find out we have endless possibilities and options to consider! It makes me hopeful, and reminds me there’s no reason to ever give up.

All of us at the GHO would like to thank Becky for taking time out of her busy schedule to be interviewed! If you are interested in getting involved with MOSH by becoming a committed volunteer or by donating, their contact information is available online. For more information, you can also follow MOSH on Twitter.

Worlds Together: Indigenous Medicine and the Canadian Health Care System

February 26, 2016 Maria Wilson Leave a Comment

This is a guest blog post written by the Indigenous Health Interest Group (IHIG) at Dalhousie University.

IHIG is an interdisciplinary group of health professions students that share a common goal of improving the health of Indigenous peoples. Please join us for a panel event at the Halifax Central Library, March 2^nd, 6:30pm. For more information, follow Indigenous Health Interest Group – Dalhousie on Facebook.

Indigenous medicine encompasses a holistic worldview. This has only recently become the more progressive understanding of health in Western medicine, where health is more accurately defined as “physical, mental, social and spiritual wellbeing” rather than simply the absence of sickness.

This conception of health is nothing new to Indigenous peoples, but is unfortunately not an ideal that is realized in many Indigenous communities today. In Canada, there are striking inequities in health outcomes for Indigenous people compared to the general population, like reduced life expectancies of 5 to 10 years. This reflects the effects of history combined with the social determinants of health. This history – which continues today – includes colonization, forced displacement and environmental degradation. The social determinants of health were grimly summarized by the Royal Commission on Aboriginal Peoples, which stated that “Aboriginal people endure ill health, run-down and overcrowded housing, polluted water, inadequate schools, poverty and family breakdown at rates found more often in developing countries than in Canada”.

It is in this context that many Indigenous communities in Canada are successfully re-building, reviving or reinforcing their cultures and practices – including Indigenous medicine. This presents an opportunity to improve care for Indigenous patients, by tackling what has historically been the total exclusion of Indigenous medicine from the mainstream healthcare system. Actively facilitating blended models that offer both Indigenous and allopathic options is one way to make the healthcare system more inclusive, effective and safe.

There are a small but growing number of examples in Canada that show how Indigenous medicine can work in parallel with the mainstream healthcare system to benefit Indigenous patients. These include the multi-disciplinary teams at Anishnawbe Health Toronto Community Health Center and the research action centre Well Living House, which provide patients a more comprehensive package of culturally-based services to meet their needs.

Dr. Margaret Chan, Director-General of the World Health Organization, summarizes the opportunity well: “The two systems of traditional and Western medicine need not clash. Within the context of primary health care, they can blend together in a beneficial harmony, using the best features of each system, and compensating for certain weaknesses in each.”

For all patients, healthcare providers should be sensitive of, and responsive to, their needs and preferences. It is also important for patients to have the opportunity to decide what health services work best for them. For many Indigenous people, healthcare may include some aspect of traditional medicine or Indigenous knowledge. Having these options available – and having them respected by non-Indigenous health providers – is important for Indigenous patients’ health and health outcomes. This is especially true because many report negative experiences with the healthcare system including anxiety, stereotyping/stigmatization and racism.

The healthcare system can become more inclusive and more effective by opening the door to Indigenous healing systems, cross cultural communication and reciprocal knowledge sharing. As current students, we can be part of this movement by engaging in discussion, learning from Indigenous communities, and building our own awareness and cultural competency. Doing so will equip us to support a more inclusive healthcare system in our future roles as providers, leaders, policy makers, and gatekeepers.

Is this relevant to Nova Scotia? In a word, yes. Whether or not we are aware, willing or able, we will provide healthcare to Indigenous patients, because:

Indigenous people comprise about 3% of the total population of Nova Scotia today
There are 42 reserve locations across Nova Scotia, but nearly half of the Indigenous population in Nova Scotia live off-reserve – in cities around the Province
There are not enough Indigenous health practitioners to be the sole healthcare providers for Indigenous communities

Local Partnerships: Dartmouth North Community Food Centre in Focus

January 20, 2016 Maria Wilson Leave a Comment

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Have you ever heard the saying “think global, act local?” This phrase was first used in the context of environmental challenges, however, it is becoming more and more relevant to the field of Global Health. Global health focuses on achieving health equity for all people, worldwide. Global health issues transcend national borders, and often impact those in our own communities. Therefore, we can begin to combat global issues by addressing them on a local scale.

The Dalhousie Global Health Office partners with a number of organizations in both Halifax and Saint John to provide a Local Global Health Elective program to first and second year medical students. The Local Global Health Elective is a half-year elective, which complements family medicine placements with community and social service organizations. This elective helps students develop a broad understanding of the health of socially marginalized groups in their own communities, and the services available to address their needs. The Dalhousie Global Health Office is also exploring building service learning opportunities to be launched in fall 2016. Stay tuned for more information about our exciting new Service Learning opportunities with UGME the coming months!

One of our newest partner organizations is the Dartmouth North Community Food Centre (CFC), a project of the Dartmouth Family Centre. The Dartmouth Family Centre is located in North Dartmouth, an under-served and high needs area: 13.5% of the population in this area is aged 65+, 31% of households are single-parents families, and 6.4% of the population are immigrants, a number that is expected to grow in coming years. The Dartmouth North CFC aims to increase the number of new entry points for families with young children, providing the community with a gathering space while expanding food access and skill-building opportunities. Community members come together to grow, cook, share and advocate for good food, through a variety of programs including a food distribution initiative, community kitchens and community gardens. You can learn more about how the Dartmouth North Family Centre combats local global health issues on their Website, Facebook or Twitter.

To learn more about our Local Global Health Elective opportunities, as well as our other offerings, check out our Website. As always, for information on our upcoming events, please check out our Facebook, Twitter or Instagram.

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