7
Several small projects have been initiated in order to determine the efficacy of AMANI's counselling service. We are
examining the efficacy of a single therapeutic interview, which may be described as a very simple approach to
debriefing. A single therapeutic interview, supplemented by family visiting, seems to be the most useful intervention in
the rural setting where patients are unable to return for regular weekly or fortnightly sessions. A selected group of
patients needing counselling has formed the cohort, and are being followed up at 3, 6 and 12 month intervals.
Additionally, a project to assess the efficacy of family therapy is being developed, and the first few families have been
seen.
(ii)Training Progamme:
The training programme aims to create the capacity in the District to manage the problems of the survivors, but it
attempts to do this within the context of a primary care psychiatry service. We believe that a programme will survive if it
meets the needs of may different groups, but that a programme focused upon one group only will not.
In 1995, staff from the hospitals in the District were trained in a basic psychiatric management approach, supported by a
specially prepared manual. The programme was later extended to the staff of the Rural Health Centres. The staff at these
centres, 22 in all, participated in a series of 5-day workshops, and were then followed up for supervision purposes by
AMANI staff at their work stations. In 1996, 2 groups of staff chosen from amongst the previously trained personnel
began an advanced counselling course; one group from each of the 2 participating hospitals. This course aimed at
providing each hospital with a core group of trained counsellors, capable of managing individual, group, family and
trauma counselling to referred patients from within the hospital and from the rural health centres.
In Zimbabwe, as in other developing countries, access to an experienced physiotherapist is rarely possible for many
patients in the community. To obviate this problem, Zimbabwe has developed a cadre of health worker, the
Rehabilitation Technician (RT), to assist the physiotherapist and occupational therapist. These workers are based at
district hospitals, and provide the first line of care for patients with physical disabilities, providing basic assessment and
rehabilitation. AMANI has begun a project to train these health workers in the assessment and management of trauma
victims, including torture and organised violence. This project has been developed together with the Provincial
Rehabilitation Department of Mashonaland Central Province. The project is in two phases, and will last approximately
12 months, and it is hoped that the project will result in basic assessments and treatments being available for trauma
victims, including torture survivors, at the district hospital level..
(iii)Community Programme:
This is the slowest of the programmes to develop, but has no less importance. The survivors are invited to community
meetings to discuss their problems as they seen them, which is the first step in creating a network of families. The home
visiting leads to local meetings of groups of families, where they share their experiences and talk about their current
problems. The current problems always revolve around poverty and its effects. The AMANI Trust, in responding to these
concerns, has begun a programme to address these, which revolves around sustainable agriculture, or “permaculture”,
small-scale income generating projects, and we hope in the future to address the problem of deforestation.
The emphasis will be on training again, with the community making the decisions about what projects to embark on and
how to organise themselves. Here we hope that the disempowerment of the 1970’s will be practically combated by
economic empowerment in the present.
Conclusions:
The aim of our programme is to empower people, not to impose anything upon them, and thus we are patiently waiting to
see the community response so we can, in partnership, develop structures and processes. It is axiomatic to us that the
process should be empowering, and nothing like the processes that originally harmed the community: the community
must have a very strong say in what develops and what is created. The community must itself break the imposed silence
of organised violence in order to be free. Thus, breaking the silence is the crucial therapeutic process for us. When
people are able to tell their stories fearlessly and with pride, then the process of disempowerment is ended. Human rights
begin and end with the right to tell our own stories, free of intimidation and abuse, and, for the survivors in Mount
Darwin District, this requires the courage to break the silence. Community development can only begin when the
community finds its voice, which requires the breaking of the silence.