2 This report has been produced in order to summarise 5 years of training in Mashonaland Central Province. The AMANI Trust has been training nurses and other health workers in Mashonaland Central Province since 1995 and it seems appropriate to take stock of what we have learned over this time. We started out with a model developed for the primary care setting and suitable for the development of a community-based mental health approach. This was originally developed during a project in Chiweshe based at Howard Hospital. The contributions of Helga Williams and Charles Todd were very important in developing the first model. The aim was to find an approach for managing common mental disorders - although we did not call them that at that time - which was so prevalent in the primary care setting in Zimbabwe. The model was epidemiologically driven and based on a solid research foundation. The next phase involved applying the model to a novel setting: the Mozambican refugee population in Zimbabwe. This was the first activity of the soon-to-be formed AMANI Trust. This was a useful learning experience in so many ways. Firstly, it became clear that non-mental health professionals could become effective counselors, and, secondly, that the preferred methods of counselling were not what we had assumed. We learned that directive techniques seemed more acceptable to clients that non-directive techniques. Here, we have to thank Rhoda Immerman who had the vision to see that trauma counselling and mental health were important in the refugee setting, and the courage to try out a relatively untested approach. Finally, we began in Mount Darwin, where Mount Darwin District Hospital and Karanda Mission Hospital gave us a warm and supportive start. Then the real learning began. We learned that problem solving is what nurses do best, and that we were effectively deskilling nurses by not using their strengths. We learned even more from our clients about the continuously de-stabilising effects of poverty and disability. We learned that we had to find ways to counter the effects of poverty, and moved into community development in a small way. We have finally moved into trauma counselling and to the training of trainers. Every year has brought new insights, and we hope that this has been reflected in the training and in the supporting manuals. We have to thank the Provincial Medical Directorate for all the support over the years and all the Districts that we have worked. We have to thank several hundred trainees for their persistence in very difficult circumstances and a demoralising work climate. We also have to thank those who gave us the tools to do this work: the Oak Zimbabwe Foundation, DANIDA, the Embassy of Switzerland, the IRCT, and the RCT. This was not possible without your support: thank you all. Training nurses in the assessment and management of psychological disorders: Report of AMANI Trust’s programme in Mashonaland Central Province, Zimbabwe.

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