Experts call for psychosocial support for road crash victims

Monday, April 12th, 2021 00:00 | By
“It is an area of concern,” said Fred Majiwa, the Head of Business Development, Programme and Emergency Services at St John Ambulance Kenya.

For many stakeholders in Kenya’s road transport sector, the issue of psychosocial support for road accident victims is a matter that has been swept under the carpet for far too long.

“It is an area of concern,” said Fred Majiwa, the Head of Business Development, Programme and Emergency Services at St John Ambulance Kenya. 

“Over the years, most of the focus has been on the physical assistance to the victims of road accidents.”

“Psychosocial support isn’t a highly regarded subject in patient care,”  stated Kevin Mubadi, the founding head of the Bodaboda Association of Kenya.  “Most accident victims are left to fend for themselves in this area.” 

Mubadi conceded that this gap calls for redress in the overall care and management of victims of road accidents.

Little options are available for the survivor, and even where available, they are few and far between. 

George Mathenge of the Association for the Physically Disabled of Kenya (APDK) suggests a county-based approach as one way of availing psychosocial assistance to those in need.

“Ideally, whenever one goes for physiotherapy in a hospital, they should have the service,”  Mathenge told Science Africa.

According to Majiwa, the psychological effect of an accident extends beyond the individual casualty to include the wider family and society.

“You find that, for every one physical victim, there are at least four other psychological victims,”  Majiwa told People Daily. 

“This is because there are people who watch these things, and they are traumatised.

There are relatives of the person who passes on, and they too are affected. This area has not been properly managed.”

Proactive approach

First responders may also suffer psychological pain when they encounter gory details at scenes of accidents.

“Even first responders who are not trained may rush to an accident scene to help, but they may fail to help themselves.

That’s because after this, they might be traumatised and require debrief or to see a counsellor.”

In addition, Majiwa noted that in the typical government hospital, emphasis is laid primarily on physical well-being of an accident victim. General perceptions of psychological therapy are also to blame.

“People’s attitudes towards it also play a role in limiting the attention given to psychological help,” Majiwa said.

“People may see psychological treatment to mean being treated as a mad person.

So, you might find that, generally, the population is reluctant to admit that they have a psychological needs that require treatment”.

Majiwa said the government has acknowledged the need for psychosocial support, while admitting that this is a relatively new area in overall patient care, and might take a while before it is fully integrated in mainstream patient management.

“What I understand is that in every county referral hospital, there is at least a section that handles mental health care, so that they can at least mitigate it at the very basic level.”

The key component in psychological care, Majiwa said, is referral, which needs to be strengthened to point people in need of care in the right direction as need arises. 

The practice at one of East Africa’s most respected brands in the health sector aligns with Majiwa’s envisaged referral model.

For an accident victim, a general physician is one way to provide assessment for possible psychological assistance on a case-by-case basis.

“Often, when a patient has outstanding psychosocial issues, primary doctors are able to recognise that and to involve the mental health workers – be it the psychiatrist, psychologist, counsellor or social worker,” Dr Ian Kanyanya of the Kenyatta National Hospital (KNH) told People Daily. 

Dr Kanyanya, a psychiatrist and Head of Department of Mental Health at KNH, acknowledges that despite the efficacy of this approach, there are limits to how many persons in need can be reached in this way.

“As much as we recognise what KNH does, we also realise it is provided to just a limited few ­— we are talking about those who are admitted in hospital, which is really just a fraction.

We realise many others may not have the obvious psychosocial disruptions necessitating intervention, and so they go unnoticed — they are treated for their fractures and they go home without the necessary interventions as far as their psychosocial needs are concerned.”

Despite relative successes of the KNH approach, Dr Kanyanya observes that more attention needs to be paid on the psychosocial well-being of the accident victim.

He urged a more proactive approach towards prevention, saying the community needs to be looped into the campaign. 

 “Our system is not tuned to prioritise these issues among people who have suffered trauma. You can get trauma from things such as accidents, war-like situations, sexual violence and so on.

Prevention, they say, is better than cure. Maybe we need to be more active in highlighting these things to the general public,” he says. 

Traumatic experiences have a lingering impact, in some cases leaving a long-lasting imprint on the victims. 

“We know symptoms of Post Traumatic Stress Disorder can flare up even years after the accident.

Generally, it is not very obvious to many people – many people may not quickly recognise that this is connected to the accident that happened, and the patients themselves may also not connect,”  he adds.

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