10 uses skills with which most nurses are already familiar. This is important when it is considered that most psychological disorders will only ever attend at the primary care or outpatient level, and where virtually all these clients will not receive specialist mental health care. Thus, an approach that requires a minimum of skill re-training has decided advantages for the primary care setting, and follows the general approach already tried in the Zimbabwean setting. Figure 5. Changes in Self-ratings: six months follow-up. Changes in Self-Rating scores. 3.5 3 Scores. 2.5 2 mean sd 1.5 1 0.5 0 Self-rating(1) Self-rating(2) Self-rating(3) Self-rating(4) Occasion of testing. 2.5 Outcome of treatment Although Amani staff themselves offered counselling to the survivors that they assessed, the primary interest in Amani’s work was in ensuring that the nurses and other health workers that they trained would be able to do this too. To this end a extensive training programme was mounted [see below], and, accordingly, a follow-up of the cases treated by the nurses and social workers trained was undertaken in 1999. AMANI staff examined the case files of all the patients seen by the Trauma Counsellor trainees and the findings are reported below. A total of 79 case files were examined. The majority of the cases were female (54) and the mean age of the cases was 31 years (sd.12.6). As can be seen from Figure 6 [see over], there were a variety of types of trauma seen by the trainees, with domestic violence and torture being the most frequent. The torture cases were all chronic cases from the Liberation War. The health workers had received training in both the assessment and treatment of survivors, and the training in treatment had revolved a number of different approaches: problem-solving, family therapy, the brief therapeutic interview, and de-briefing. The training was bolstered by the provision of a number of manuals, developed especially for this programme13. 13 See Appendix 1 for details of the manuals, copies of which may be obtained from the Amani Trust. AMANI TRUST: Psycho-Social assistance to Survivors of the Liberation War. A report on Mashonaland Central Province, Zimbabwe.