18 Generally, the nurses found their new skills useful, particularly in respect of sexual assault and abuse cases. One forensic nurse was accepted as an expert witness in a child rape case in the Chinoyi Provincial Magistrate’s court: presiding magistrate said in this case that he wished there more forensic nurses in order to expedite such cases. At the review, the nurses also pointed out that their documentation of all cases had improved as a result of the training, and their new understanding of the importance of examination and documentation. 3.6 Developing District mental health services In order to consolidate the training, the Amani Trust also made an attempt to work with the District health team to develop a referral and treatment system. The major aim here was to protect the trained nurses from having to handle cases beyond their expertise, since observation and experience had shown that the most frequent de-motivating factor for nurses applying their skills was having to manage extremely difficult cases. Whilst these were generally cases of major mental disorder, they were not exclusively so, and frequently complex cases involving family disputes were found to be beyond the capacity of nurses in primary care clinics in the community. Here it must be remembered that nurses living intimately within the communities that they serve, and are as much at the mercy of complex community problems as their patients. In order to ensure that the District retained the capacity to manage psychological disorders and survivors of violence, Amani initiated discussions within the District aimed at formulating a District psychiatric policy. Representatives from Amani, Mount Darwin District Hospital, Karanda Mission Hospital, and the Provincial Medical Directorate met to fulfill these aims. This group produced a management algorithm for the District, which was implemented after a pilot period. Additionally, Amani was requested to assist the District in the preparation of a project proposal for the establishment of a District Psychiatric Unit. Amani assisted by conducting a series of point prevalence studies at the hospitals and several rural health centres, and the compiling of a detailed statistical analysis of the presenting problems. The findings of this research indicated a clear need for a developed psychiatric service in Mount Darwin District. Following the suggestions of the World Health Organisation and local Zimbabwean workers, some recommendations were made as to how this service might be organised, as well as the likely needs for such a service. These recommendations were accepted in full by the Hospital Management Board and the modalities for implementation worked out. The Amani Trust’s work not only lead to a greater awareness of the problems caused by organised violence and torture, but also lead to both a greater awareness of psychological disorders with a commitment to provide an improved service to these patients. AMANI also supported the Districts directly with clinical supervision visits following the training workshops. These visits were frequently a mixture of training and consultation. On average, every clinic, and the person trained by AMANI, was seen at least once every two months. 4. Community work: As indicated above, the Amani Trust had, from the outset, a view that a community-based approach was fundamental to the development of an effective programme. 4.1 Family visiting The first stage of the community programme involved the visiting the homes and families of all identified survivors. This was done so that the functioning of the families could be assessed, as well as determining what levels of support were available for both the survivor within the family, and the family within the community. It became very clear from the outset that the survivor families displayed many features of social and psychological dysfunction. For example, early work showed that the AMANI TRUST: Psycho-Social assistance to Survivors of the Liberation War. A report on Mashonaland Central Province, Zimbabwe.