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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.