Established in 2009, the Mobile Outreach Street Health van (MOSH), brings primary health care to the individual, meeting people where there is a greater level of comfort, and establishing trust, building relationships, and improving health outcomes. In our latest Connecting with Care film, we delve into this nurse-led, van-based model of care.
In the province of Nova Scotia in Canada, the north end of Halifax is a vibrant community with excellent nightlife and café culture. It’s also traditionally the neighbourhood where many of the city’s most marginalised live and spend their time. For this reason, many of Halifax’s harm reduction services are also based here, including the North End Community Health Center, MOSH clinic, Direction 180 and Mainline Needle Exchange.
Since 2009, the Mobile Outreach Street Health van, commonly referred to as MOSH, has been helping people access health services on their terms. In an era when stigma and discrimination towards people who use drugs is significant, this nimble and discreet van – a clinic on wheels – has allowed the MOSH nurse team to quickly move around Halifax and neighbouring areas of the Nova Scotia province and provide a range of health services and injecting equipment for the city’s drug user community.
The power of a nurse-led model of care
Nurse Practitioner Jac Atkinson has been a regular fixture at MOSH over the years, and many street-based drug users and marginalised communities across the city know her by name.
However, even before she became a nurse practitioner and a prescriber of the new hepatitis C direct-acting antiviral medication (DAA’s), she was always as equally interested in providing health care as she was in assisting the person to navigate the often-complicated health system.
One of the greatest things about nurses is that they’re real resource finders. They know who’s doing the good work and can help maintain and make connections to that work. Nurses also understand the healthcare system and how to get around all of the burdensome barriers. And I think that’s the magic with MOSH. Most of what we do is not medicine, it’s about building relationships and navigating our complicated healthcare system, and nurses excel at that.
Reaching more people with direct-acting antiviral treatment for hepatitis C
Since its humble beginnings, MOSH has grown significantly in size and scope. MOSH now has three clinicians, and a roster of nurses and occupational therapists who work between the MOSH van and the North End Community Health Centre office.
Today the MOSH van has significantly upgraded from its original small commuter van to a large Mercedes-Benz Sprinter van that was donated by Canadian telephone company Telus. MOSH nurse Harold Cook refers to it as a ‘doctor’s office on wheels’.
MOSH is exceptionally fortunate to have staff such as Dr. Mike Gniewek and Dr. Leah Genge, who are part of the next generation of clinicians passionate about health care, harm reduction and human rights.
In 2022, the pair both received approval to begin prescribing DAA medication for hepatitis C. This green light to provide hepatitis C care was an exciting step for MOSH as it significantly broadened the number of providers that could offer hep C treatment both on the MOSH van and in their bricks and mortar office.
Building lasting relationships with the community
Cathy Bonang has called Halifax and the surrounding areas of Nova Scotia province home for much of her life. Since MOSH was first established, Cathy, has been a regular visitor to the van for sterile injecting equipment and her primary health care needs. Over the years, Cathy has forged a deep bond with Nurse Practitioner Jac Atkinson.
Upon her release from prison, Cathy could link straight back in with Jac on the MOSH van for hepatitis C testing and then treatment. Cathy’s relationship with Jac has never been primarily about accessing hepatitis testing or picking up equipment. Often, the twice-weekly van visits are her chance for human connection with people she trusts and in a space where she feels safe. More recently, this has led to Cathy engaging with other MOSH staff to address different needs. Recently, she was initiated into the safe supply program run by MOSH doctors Dr. Mike Gniewek and Dr. Leah Genge.
The importance of safe supply
Safe supply helps so many other outcomes, and is about a lot more than overdose deaths. It’s also about not having to participate in crime to fund opioid use. Instead, we’re going to write a prescription for the pharmacy. That’s a reliable, everyday thing that’s an important broader scope of safe supply. It reduces interactions with the legal system, incarcerations, and survival sex work. The benefits are really present if you look between the lines.
MOSH is synonymous with non-judgmental, deeply responsive, and empathetic care. With more hepatitis C prescribers on staff and an increased overall footprint, MOSH continues to provide a broader impression of health and harm reduction services. Each day across the city, Halifax residents can be guaranteed to find a MOSH nurse or doctor out and about in the ‘doctor’s office on wheels’.
The nurse-led MOSH model that emphasises flexibility and reliability is crucial to the organisation’s ongoing success. For many of the city’s marginalised, MOSH is an organisation of healthcare providers who can meet their primary healthcare needs while also striving to support and advocate on their behalf for many of the other daily challenges in life.