MOSH

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.

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.

MOSH minivan

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.

Mainline Needle Exchange

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.

Halifax, NS

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