By Kendall Worth

I recently interviewed Sam Krawec, who is the Health Case Manager with MOSH. Mosh is a service provided by the North End Community Health Centre that provides Healthcare Services to the under-served population in our community. This includes providing services to the homeless population and to those who are living in insecure housing. Community members sometimes misunderstand what the MOSH van is, so I interviewed Sam to get the scoop on what MOSH is, and here are his answers.

Kendall and the MOSH van.

#1 - Can you tell me about the history of when the MOSH van started and the general idea behind why the MOSH Exists?

Mobile Outreach Street Health (MOSH) was started in 2009 by Patti Melanson, a Registered Nurse (RN), and Diane Bailey, the Executive Director of Mainline Needle Exchange. At the time, there was even less support than there is now for people who were homeless or street involved, and for people who have been living with addiction and mental health related challenges.

In Patti's words:

"We created a health care service that delivers health care exactly where people are, literally and figuratively. We go to where they are... We also appreciate where they might be in their lives, and what they might want done and what they might not want done."

Many community and government agencies have worked on making MOSH what it is, and the North End Community Health Centre is now the sponsoring agency with funding from Capital Health. 

When MOSH started, outreach staff worked out of a customised Toyota minivan that was used as a “clinic on wheels.” That van is still used, but since 2020 the main MOSH clinic van is now a Sprinter Cargo Van with a much larger amount of space in the back, recognizable as the ‘NECHC Mobile Health Clinic - Telus Health’.

 

#2 - It is my Understanding and the understanding of the Community that the MOSH is available as a service for those living in poverty as well as for those who are homeless. Can you Clarify this and who qualifies to use the services of the MOSH Van, and is there anything you can tell me about success stories of where Persons living in poverty health have improved resulting from them using the services of the MOSH Van?

MOSH provides accessible primary health care services to people who are experiencing homelessness, insecurely housed, street involved and underserved in our community.

MOSH gives people some kinds of support that they generally cannot get from other health services like walk-in clinics or emergency rooms. We have wrap-around supports that help people address overlapping barriers like addiction, access to housing, and the criminal legal system.

The MOSH van is often a first point-of-contact for many of the people we support. We often meet people when they are living outside, living in shelters, or insecurely housed, and we can support them with finding and maintaining housing, addressing mental health and addiction challenges, and living how they want to. For certain people, we have been able to offer tangible support with health and housing while also building a sense of community and belonging with them.

#3 - It came to my attention from several Sources in my Community that one specific service the MOSH Van offers is a program for low income and Homeless who complain they cannot afford to buy Alcoholic Beverages, and some whom the MOSH Van serves needs this product in-order to live day-to-day life. Can you tell me whether or not this is true? What would be an example of a medical reason as to why those people would need to drink Alcohol, and what program do you have or offer that helps these people deal with their alcohol addition? Are there any success stories where the people you serve have stopped drinking because of the services of the MOSH Van?

The North End Community Health Centre has a Managed Alcohol Program (MAP) that began in summer 2020.

MAP works through a medicalised harm reduction model, which means it is nurse-led and provides a consistent, safer supply of alcohol prescribed by a physician through a government permit.

The program aims to reduce some of the harms associated with Alcohol Use Disorder (AUD), a medical condition where someone has an impaired ability to stop or manage their alcohol use, sometimes because of a physical dependence developed over time.

MAP uses daily outreach and non-judgmental settings to support clients with living safer, healthier lives. Most recently, after beginning hourly MAP doses at a supported housing site, support staff have noticed considerable improvements in people's well-being. There is less over-intoxication, more engagement and activities, folks playing games, watching sport highlights, listening to music, and having supportive conversations. 

 

#4 – Given the current Housing Crises in Halifax has the scope and volume of your work changed due to larger clientele; and, if yes can you talk about how and why?

When MOSH started in 2009, there were 158 people known to be homeless in the Halifax Regional Municipality. On the latest By-Name List report in August of this year, there are 1012 people known to be homeless.

There are many people who are newly unhoused, who do not experience as many barriers as people MOSH has supported before. This means there are now more people approaching the MOSH van and the NECHC housing programs than we are staffed to support.

Related to this, the wait-list for a family doctor in Nova Scotia recently passed 150,000 people, and many people without a family doctor are also coming to MOSH with nowhere else to go.

The MOSH team has grown considerably, but things like MOSH are not the answer to these crises. The increasing lack of access to housing and healthcare is a widespread problem that calls for structural solutions.

#5 - Is there anything else you can say about the MOSH Van's services that the Community needs to be better aware of, or anything else you want to add, generally.

MOSH is part of a large community of service providers who work together on supporting many of the same people.

We work closely with Adsum for Women and Children, The Bridge, Brunswick Street Mission, Bryony House, Direction 180, Mainline Needle Exchange, Welcome Housing, Salvation Army, Soul’s Harbour, Shelter Nova Scotia, the Mi’kmaw Native Friendship Centre and their new Wije'winen Health Centre, and many others.

 Together we can help some people survive and thrive, but to make things better for everyone we have to fight back. Workers at MOSH and these other organisations are a key part of building movements for a better world

 __________________________________________________________

In closing  this post - let me say that I hope people understand MOSH better now.