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After the recent political events in Tunisia, I think few people would have difficulty in placing this small country on a world map. With 10.5 million inhabitants (65% in cities), there are about 100 registered neurologists in the public and private health sectors altogether, most of whom practice in the bigger cities along the coastline (figure 1). In addition, there are 10–15 new residents in training per year, which is reasonable, but probably not enough to cover the needs.
Having read the neurological letters from around the world published in Practical Neurology within the last 3 years, I am not surprised by the similarities in neurological services between Tunisia and other developing countries, like Brazil or Jordan. In spite of having four teaching medical schools, Tunisia has only six departments of neurology, three of them in the greater Tunis. There are two departments of neuropaediatrics (in Tunis and Sfax, the second largest city) and one formal stroke unit (in Tunis). Many rural areas do not have an on-site neurologist, or may at best offer a visiting neurologist a few days a week or even a month, from the major regional hospital. This is the case for Kasserine and Sidi Bouzid, in western and central Tunisia, where the ‘jasmine’ revolution started in December 2010 (a very poor name choice, indeed). On the other hand, several private hospitals in Tunis and Sfax boast fully-fledged 3-tesla MRIs with tractography and functional MRI capability.
As average life expectancy increases (to 75.9 years, according to the WHO) and general living standards improve, so do the neurological pathologies change. Neurologists see more patients with …
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