For Brian Muchiri, a night about town set off a series of events that saw him bound to a wheelchair for the rest of his life and with it, a series of psychosocial issues he had to face. The lack of adequate psychosocial support for victims of road accidents in Kenya, presents a yawning gap in their care and management, an investigation by ScienceAfrica Journal reveals. Little has been done to institutionalise psychosocial support in the overall treatment regimen of a road accident victims in the country, with much of the focus and resources being invested towards their physical treatment needs. The problem is more pronounced among critically injured people, who are forced to contend with life-altering physical injuries amid underlying psychological trauma. This is the case for Brian Muchiri. With a charming glint in his eye when he converses, a healthy gleam in his cheek, and a graceful smile bereft of remorse flashes on his face from time to time, there\u2019s practically nothing in his face that would betray the catastrophic turn of events seven years ago that robbed him of the pleasures of young adulthood, and consigned him to a wheelchair \u2014for life. One day in February 2014, he was involved in a road accident. Three of his friends died on the spot after the car they were travelling in collided head-on with a trailer along the Nakuru-Kabarak road. Brian and one friend escaped with their lives. On the eve of the accident, a friend had urged Brian to sneak into town for some fun, in what would be Brian\u2019s first night out. \u201cIt was on a Friday night and I was already in bed, preparing to sleep. A friend called me up and asked me to join him and other friends to go out. I was apprehensive, but then I saw it as an opportunity to have fun, which was rare in the village,\u201d says the 26-year-old. Unpredictable nature Brian has no recollections of the moments immediately following the crash. He was informed later on that well-wishers took him to hospital. He surmises that, in the process of transporting him to hospital, the first responders may have handled him in a manner that could have worsened his spinal chord injury, despite their noble intentions. They put him in a sitting position in a car. His parents received a call that Saturday morning informing them of their son\u2019s predicament in hospital. \u201cMy injury affects my body in a big way because I have no feeling of sensation anywhere beyond or under my armpits. I\u2019m what we call a quadriplegic: an individual with limited or no use of both limbs. I don\u2019t have use of my lower limbs, but I have limited use of my upper limbs. The bigger muscles work \u2013 like my biceps - but I have no movement beyond my wrists. I can\u2019t control my fingers,\u201d he says. The firstborn among three boys, Brian also lost control of several body functions. At the time of the accident, Brian, then 19, was in his third year at a local university campus in Nakuru town, pursuing a course in purchasing and supplies. Depression would eventually set in, as he came to terms with his predicament. \u201cMy youth was affected by the disability,\u201d Brian said at his home in Mangu, Nakuru county. \u201cI can\u2019t be at par with my peers. As they finished school I was still recovering. As they got jobs and started families, I was still here. I am a few steps behind in milestones you may think of in normal progression of life.\u201d \u00a0 The unpredictable nature of road accidents means that most people are caught off-guard, with little or no means of countering the emergent challenges. \u201cYou can\u2019t reason when you\u2019ll have an accident, and you cannot necessarily precipitate it, or anticipate it, unless you go the insurance way,\u201d said Dr Geoffrey Wango, a Senior Lecturer in counselling psychology at the University of Nairobi. \u201cSo, when an accident occurs, most people go through the stages of grief \u2013 shock, disbelief, anger, negotiation and eventually, acceptance. When people get involved in accidents, they usually don\u2019t know how to deal with it. They may not be prepared, and their families may not know what to do.\u201d The typical home may not have the requisite infrastructural layout to optimally accommodate the accident victim, notes Dr Wango, saying that adjustments are usually required at household level to assist with mobility, feeding, sleep, sanitation and other day-to-day functions. The accident itself is cause for painful recollections, but so is the reality of a new life beset with challenges.\u00a0 \u201cThe person actually goes through such traumatic moments that they may not even know who they are,\u201d stresses Dr Wango. \u201cImagine being a healthy, well-functioning individual, and you are suddenly confined to the house, unable to even move to the toilet. How do you accept yourself? You feel degraded. You may feel you are not of worth. In extreme cases, the patient may slink into an abyss of oblivion, marked by intense loneliness, when acquaintances and the community shuns your company. As you can imagine, the higher your social status, the lower you go in such circumstances. And, the more intensive your injury, the more people may dismiss you.\u201d And so the psychological trauma sets in, with the realisation of lost functionality, lost career or other developmental prospects, and a generally dented future. Self-acceptance is a key area of focus in the psychological treatment of accident victims, geared towards building resilience. Support, says Dr Wango, should come from all possible quarters, including family and friends. He says it is particularly encouraging to see that religious formations also make a point of visiting and communing with accident victims. \u201cThe person needs to accept what happened, what they are going through, and what they can do about their life. That\u2019s the ultimate remedy. The more resilient individuals tend to do it better than those who refuse to accept what they are going through.\u201d\u00a0 Dr Wango laments that institutions generally do not pay attention to the psychological needs of person inflicted with trauma. \u201cVery few organisations are bothered about psycho-traumatic support systems, including counselling and therapy. \u201cHardly anybody thinks about them. When one is involved in an accident, everybody is preoccupied with healing, and they generally go for the physical, and not the psychological, which is sidestepped,\u201d Dr Wango said. Despite the palpable drawbacks on his young life, Brian has taken it all in his stride. He is the founder of Strong Spine Foundation, an organisation that seeks to empower and advocate for inclusion and equality for people with disability.\u00a0 But the toll on his family has been great. Aside from the high cost of treating his physical disability, his family has had to commit numerous resources towards his care and well-being. He relies heavily on his wheelchair and a caregiver, a role that has been shouldered by his parents. Every morning, his father assists with his bath and dressing up. He also wakes up twice a night to help Brian turn in his sleep, to prevent pressure wounds. He uses a catheter for his bladder and adult diapers for his bowel movements. \u00a0\u201cI didn\u2019t get any kind of professional support for my mental health. Maybe I didn\u2019t realise that I was going through something so serious, or if at all I even needed it. I didn\u2019t even know that it was an option,\u201d he says.