3
families. Thus, a two-pronged approach was developed: one strand aimed at assisting survivors and
their families to become better advocates in their own cause, whilst the other strand aimed at
protecting families through income-generation. Here, it was felt that the family visiting component
was less useful than an approach that brought all geographically-contiguous survivor families together.
Similarly, it was decided in 1997, in consultation with the Provincial Medical Directorate of Mashonaland
Central Province, that the district-by-district roll out plan was possibly too laborious, and that it would
be more desirable to train a cadre of nurses in the Province in trauma counselling skills. This decision
was confirmed by a survey carried out in 1997 [see below]. Accordingly, the Amani Trust began a new
programme to train trauma counsellors from each District. This programme was subsequently run in
the urban setting, in Chitungwiza, following the Food Riots in 1998, where it was noted that there was
a potentially large number of survivors now living in the urban setting.
It was also the case that changes in the programme led to new directions being taken. One
consequence of the move to train trauma counsellors was the understanding of the need for forensic
capacity in many districts. This led the Amani Trust to run, in conjunction with the Zimbabwe Nurses
Association [ZNA], a course in Forensic Nursing. This was one of the first such courses in Africa. This
resulted in the training of 22 nurses from virtually every Province in the country. This exciting start
has not, however, been followed up by the Ministry of Health and Child Welfare, or the Zimbabwe
Nurses Association.
However, the programme that was developed in Mashonaland Central Province overall provides a
useful model to examine for the treatment and management of survivors of OVT, and this paper details
briefly many of the aspects of the programme, as well as offering a critique of its strengths and
weaknesses.
2.
Psychological assistance:
Since the most persistent consequence of OVT is psychological disorder3, considerable attention was
given to offering this form of assistance to the identified survivors. It was evident from the outset that,
in common with the other Zimbabwean work on community mental health care, that it was not possible
to assume that standard Western approaches to counselling and psychotherapy would be appropriate
in the rural Zimbabwean setting. Thus, the Amani Trust devoted a significant part of its efforts to
investigating appropriate management, and this ranged from studies of innovative psychotherapies
through to attempts to develop more rational health delivery. All of this work was conducted mindful
of the broader mental health picture and the need to integrate assistance to the survivors of OVT into
the existing health care system as opposed to developing stand-alone services. What follows below is
a summary of this work.
2.1
Brief Therapeutic Interview
Following on work done by Gillian Straker4, the Amani Trust investigated the utility of a brief
intervention, which was termed the Brief Therapeutic Interview5. This approach was developed
following the observation that many survivors showed marked symptomatic improvement merely as a
consequence of detection, an observation noted earlier in other Zimbabwean work in the primary care
setting6.
3
As to what “psychological disorder” means with torture survivors, there is considerable dispute. Here see Reeler, A.P.(1994),
4
See Straker, G. (1987), The continuous traumatic stress syndrome - the single therapeutic interview, J.SOC.DEV. IN AFRICA,
5
Is torture a post-traumatic stress disorder? TORTURE, 4, 59-65.
8, 48-78.
It was originally termed the Single Therapeutic Interview [STI], but this was changed to the Brief Therapeutic Interview as
the term, STI, was easily confused with a similar acronym referring to “sexually transmitted infections”.
6
See Reeler, A.P., Williams,H., & Todd,C.H.(1990), Controlled trial of nurse treatment of psychological disorders: A rural primary
care study, RESEARCH DAY, SCHOOL OF MEDICINE, UNIVERSITY OF ZIMBABWE, 15 SEPTEMBER 1990. This study showed
AMANI TRUST: Psycho-Social assistance to Survivors of the Liberation War.
A report on Mashonaland Central Province, Zimbabwe.