The Health Care System

 Not surprising, rich people live on average 10 years longer than the poor, this is due to life style, healthier food (not so much junk/fast food), usually better education and being in a position to afford first class medication and specialists. Generally speaking the health system isn't bad here, the best in Africa actually. Yet most private hospitals and medical facilities are located in major cities.Thus in rural areas universal access to basic health care is limited. You may have to travel quite a distance to the next clinic/ medical facility and in case of an emergency loose precious time. The poor can obtain a paper that entitles them to free health care in government funded clinics, but they may have to wait for 3-4 months for an appointment or without an appointment spent several hours in the waiting room. I visited a clinic once only to discover approx. 500 patients had already arrived, so I left to see a private expert instead. Those who can afford this are lucky, yet you can always find many patients in the waiting rooms of the various medical practitioners and specialists. Quite a few studied in Europe, often France or Germany. The usual consulting fee is 50 Dinar in Souse, appears to be less in some other towns, e.g. in Kairouan, (a good, dedicated general practitioner in modest facility charged only 30 Dinar) extra pay for injections etc. Blood tests and x-rays are carried out in other specialist practises, unless you are in a hospital or clinic. Smaller medical facilities for out-patients, opening hours rather limited, and maybe only 1 or 2 employed practitioners, perhaps less qualified, charge less. Hospitals are said to be better equipped, the standard is generally much higher and this included the doctors' qualification and therefore you are required to pay more for consultations. Most expatriates and foreign visitors use private clinics. Many Tunisians buy into insurance schemes which partially refund costs of treatment. If you are forced to continue paying health insurance contributions of and to an European country (not at all a small amount), according to an agreement between the Tunisian government and the concerned country, the "CNAM" (Tunisian national health insurance) receives a minor amount of your contributions and this can entitle you to get a little  bit refunded if you go to the state funded clinic for treatment, or are chronically ill and get your prescriptions from there. My personal experience with CNAM: bad service, unfriendly staff - though I never ever even received a milliem (smallest coin here, rarely ever used) from them. Quite a few expats are unhappy with that system, but they are often unaware how small the amount of money is that European countries/ health insurances actually pay. Most opticians, dentists (73 %), pharmacists (80%) and doctors (50 %) work in the private sector, some part-time in hospitals or clinics as well. In the clinics' dispensaries the poor can obtain their medication for free - but it is not always available due to faults in the public procurement system, perhaps even false prescriptions, wrong distribution (corruption, the government tries to solve this). So they may be forced to buy their medication at the pharmacist' who is expected to provide cheap medicine. Though the price is certainly much lower there than e.g. in Germany, the price is also influenced by the country of origin. Imports from Italy, France, Swiss or Germany (supposed to be of higher quality) are quite a bit more expensive than local productions, (still an attractive price for European tourists) and this reduces the demands and supply. Thus you can't always get what you want, even if you can afford a higher price. Some pharmacists are in addition doctors and can therefore provide professional advice to customers who want to save time and money for consulting a surgeon, and one can get an injection there for 1 instead of 10 Dinar. This method may not always be advisable and I would think that those who should receive a thorough medical examination will be advised accordingly. - Many illnesses are caused by constant stress, this could be reduced by noise-restricting laws, not just for companies but for private households and individuals as well. I am under the impression that folks here love creating quite unnecessary noise with which they "pollute" the air, just like children, and not surprisingly everybody (including me meanwhile) seems to be very nervous and it leads to high blood pressure or even worse illnesses. (I need noise-proof walls). Scientists say sugar is the number one killer. For unknown reasons in Arabic countries and in Turkey folks use extreme amounts of sugar, this is the sugar one can see in tea, coffee and on cakes, and and then there is in addition the less obvious sugar in soft drinks and in various ready-made foods on sale. In soft drinks it is very high, mend to give flavour and make you addicted (very sweet, your flavour). Junk food is very popular among children and teens, as I can see by the wrappings on my pavement, every day, they learnt quickly that in spite of the new law/ regulation (to achieve a beautifully clean Tunisia) they can continue their old bad habit to dump their rubbish anywhere, no one there to impose a fine! Hope this will change one day. For a healthier population we need more education work, less fast food and instead slow-food restaurants as well as information for parents concerning the importance of healthy home-cooking.