13 3. Training Health workers: As indicated earlier, the Amani approach to assisting survivors was built around a holistic strategy that saw a community mental health focus as central. In this focus, the devolving of skills to the District level and the primary health centre was fundamental. Thus, the training of health workers in the skills necessary for the management of psychological disorders, and disorders due to trauma, became a major activity. Between 1995 and 2000, the Amani Trust invested great energy and resources in the training of health workers, and here the focus was primarily upon nurses who were, and still are the core of the district health service. What follows below is a summary of this work. 3.1 Primary care nurses Since 1995, the AMANI Trust had been in a collaborative relationship with the District Health Team of Mount Darwin District. Although the primary focus was on developing assistance to survivors of torture and organised violence, the aim was also to strengthen the District’s psychiatric service. To this end, a series of small studies were conducted, and, although these were mainly concerned with examining the effects of the violence in the 1970’s on the survivors, these reports were relevant to the development of a District Psychiatric service. Following on an initial pilot study in 1995, AMANI introduced a community-based programme in Mount Darwin District to address these problems; both the ordinary psychological disorders, but also the disorders due to torture and organised violence. This programme ran from March 1995 to September 2000, when it had to be curtailed. As a part of this community-based programme, the AMANI Trust ran training courses in primary mental health care for nurses, as well as other health workers. The basic training focused on the basic knowledge and skills for detecting, assessing, and managing psychological disorders presenting to primary care and hospital outpatient departments. The course also contained an input on the assessment and management of survivors of organised violence and torture. Manuals were developed to support this basic course14. About 150 nurses and health workers went through this course in three Districts – Mount Darwin, Muzarabani, and Centenary. 3.1.1 The Basic Skills Programme 1995 – 1998 The major objective of the Basic Skills Programme was to create awareness in the health team of the prevalence of CMD, and to provide basic skills in the detection assessment and management of these disorders. There was also input on disorders due to organised violence and torture since these had been shown by epidemiological studies to be a very common sub-set within CMD. The programme revolved around the following areas and was supported by a manual 15: • • • • • • • Definition of the common psychological disorders; Classification of psychological disorders; Identification of the incidences of hidden psychiatric morbidity; Detection of psychological disorders including the use of SRQ- 8; Completion of the psycho-social histories of patients; Selection and referral of clients appropriately; Application of basic counselling skills and simple intervention methods. These were very successful courses, and strongly endorsed by both the trainees and the management. The training led to a much greater awareness about both CMD and OVT and to the formation of District Mental Health teams. 14 See AMANI. [1997](A), Survivors of Torture in Mount Darwin District, Mashonaland Central Province: Overview of Report and Recommendations, LEGAL FORUM, 9, 49-60. see also AMANI.[1997](b)], Report on Psychological Disorders in Clinics and Hospitals in Mount Darwin District, Mashonaland Central Province, HARARE: AMANI. 15 See Reeler,A.P. [1995], The Chiweshe Nurse-Counsellor Programme: Resource Manual (revised), HARARE:AMANI; Reeler,A.P. (1995), Assessment of the Consequences of Torture and Organised Violence: A manual for field workers, HARARE:AMANI. AMANI TRUST: Psycho-Social assistance to Survivors of the Liberation War. A report on Mashonaland Central Province, Zimbabwe.