Skip to main content
SpringerLink
Log in

Living with diabetes and hypertension in Tunisia: popular perspectives on biomedical treatment

International Journal of Public Health volume 60, pages 31–37 (2015)Cite this article

Abstract

Objectives

The growing prevalence of non-communicable diseases across the Middle East and North Africa poses major challenges for underfunded health services. This article presents data on the perspectives of ordinary Tunisians who are coping with two of these diseases—diabetes and hypertension—and who are obtaining treatment through Tunisian public health clinics. Little has been written to date on patient experiences of biomedical treatment in Maghreb countries.

Methods

Based on qualitative methods and semi-structured interviews with 24 patients attending two clinics, one urban and one rural.

Results

We examine popular aetiological beliefs, ideas about biomedical treatment and its implications, and comparative views on the benefits and drawbacks of treatment in both public and private clinics.

Conclusions

We highlight two main themes. One was nostalgia for a recent past when ‘pure’ and ‘natural’ food, ‘proper’ meals and less stressful lives meant less chronic illness, with demanding and costly treatment. The other concerned communication in the clinic, and the recurrent dismay patients felt at what they saw as the cursory attention and guidance they received from clinic staff in public facilities.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

References

  • Adib S (2004) From the biomedical model to the Islamic alternative: a brief overview of medical practices in the contemporary Arab world. Soc Sci Med 58:697–702

    Article  PubMed  Google Scholar 

  • Ben Romdhane H, Skhiri H, Khaldi R, Oueslati A (2002) Transition épidémiologique et transition alimentaire et nutritionnelle en Tunisie. In: Sahar A (ed), Le Bihan G (coord) L’approche causale appliquée à la surveillance alimentaire et nutritionnelle en Tunisie. Montpellier, CIHEAM, pp 7–27. (Options Méditerranéennes: Série B. Etudes et Recherches; n. 41). http://om.ciheam.org/om/pdf/b41/03400042.pdf

  • Ben Romdhane H, Haouala H, Belhani A, Drissa H, Kafsi N, Boujnah R, Mechmeche R, Slimane ML, Achour N, Nacef T, Gueddiche M (2005) La transition épidémiologique, ses déterminants et son impact sur les systèmes de santé à travers l’analyse de la tendance des maladies cardiovasculaire en Tunisie. Tunis Méd 83:1–7

    PubMed  Google Scholar 

  • Ben Romdhane H, Husseini A, Jabbour S (2012) Non-communicable diseases-II: focus on cardiovascular diseases. In: Jabbour S, Giacaman R, Khawaja M, Nuwayhid I (eds) Public health in the Arab World. Cambridge University Press, Cambridge, pp 164–177

    Google Scholar 

  • Bowman S, Unwin N, Critchley J, Capewell S, Husseini A, Maziak W, Zaman S, Ben Romdhane H, Fouad F, Phillimore P, Unal B, Khatib R, Shoaibi A, Ahmad B (2012) Use of evidence to support healthy public policy: a policy effectiveness-feasibility loop. Bull World Health Organ 90:847–853

    Article  PubMed Central  PubMed  Google Scholar 

  • Boym S (2001) The future of nostalgia. Basic Books, New York

    Google Scholar 

  • Dole C (2004) In the shadows of medicine and modernity: medical integration and secular histories of religious healing in Turkey. Cult Med Psychiatry 28:255–280

    Article  PubMed  Google Scholar 

  • Dole C (2006) Mass media and the repulsive allure of religious healing: the Cinci Hoca in Turkish modernity. Int J Middle East Stud 38:31–54

    Article  Google Scholar 

  • Elasmi M, Feki M, Senhaji H, Jemaa R, Hej Taieb S et al (2009) Prévalence des facteurs de risque cardiovasculaires conventionnels dans la population du grand Tunis. Revue d’épidémiologie et santé publique 57:87–92. doi:10.1016/j.respe.2008.12.010

    Article  CAS  Google Scholar 

  • Giacaman R (1988) Life and health in three Palestinian villages. Ithaca Press, London

    Google Scholar 

  • Good B, Del Vecchio Good M-J (1992) The comparative study of Greco-Islaami medicine: the integration of medical knowledge into local symbolic contexts. In: Leslie C, Young A (eds) Paths to Asian medical knowledge. University of California Press, Berkeley, pp 257–271

    Google Scholar 

  • Mateo Dieste J (2012) Health and ritual in Morocco: conceptions of the body and healing practices. Brill, Amsterdam

    Book  Google Scholar 

  • Maziak W, Critchley J, Zaman S, Unwin N, Capewell S, Bennett K, Unal B, Husseini A, Ben Romdhane H, Phillimore P (2013) Mediterranean studies of cardiovascular disease and hyperglycaemia: analytical modeling of population socio-economic transitions (MedCHAMPS)—rationale and methods. Int J Public Health 58:547–553. doi:10.1007/s00038-012-0423-4

    Article  PubMed  Google Scholar 

  • Mokhtar N, Elati J, Chabir R, Bour A, Elkari K, Schlossman NP, Caballero B, Aguenaou H (2001) Diet culture and obesity in Northern Africa. J Nutr 131:887S–892S

    CAS  PubMed  Google Scholar 

  • Morsy S (1988) Islamic clinics in Egypt: the cultural elaboration of biomedical hegemony. Med Anthropol Q 2:355–369

    Article  Google Scholar 

  • Morsy S (1993) Gender, sickness and healing in rural Egypt: ethnography in historical context. Westview, Boulder, CO

    Google Scholar 

  • Obermeyer CM (2000a) Pluralism and pragmatism: knowledge and practice of birth in Morocco. Med Anthropol Q 14:180–201

    Article  CAS  PubMed  Google Scholar 

  • Obermeyer CM (2000b) Risk, uncertainty and agency: culture and safe motherhood in Morocco. Med Anthropol 19:173–201

    Article  CAS  PubMed  Google Scholar 

  • Phillimore P, Zaman S, Ahmad B, Critchley J (2013) Health system challenges of cardiovascular disease and diabetes in four Eastern Mediterranean countries. Glob Public Health 8. doi:10.1080/17441692.2013.830756

  • Ploubidis G, Mathenge W, De Stavola B, Grundy E, Foster A, Kuper H (2013) Socioeconomic position and later life prevalence of hypertension, diabetes and visual impairment in Nakuru, Kenya. Int J Public Health 58:133–141. doi:10.1007/s00038-012-0389-2

    Article  PubMed  Google Scholar 

  • Ricoeur P (2005) The course of recognition. Harvard University Press, Cambridge, MA

    Google Scholar 

  • Saidi O, Ben Mansour N, O’Flaherty M, Capewell S, Critchley J, Ben Romdhane H (2013) Analyzing recent coronary heart disease mortality trends in Tunisia between 1997 and 2009. PloS One. doi:10.1371/journal.pone.0063202

  • Spadola E (2009) Writing cures: religious and communicative authority in late modern Morocco. J North African Stud 14:155–168

    Article  Google Scholar 

  • Tinsa F (2011) La maladie chronique en Tunisie: approche sociologique. Faculte de Medecine de Tunis, Tunis

  • Turner B (1987) A note on nostalgia. Theory Cult Soc 4:147–156

    Article  Google Scholar 

  • Wong M, Leung M, Tsang C, Lo S, Griffiths S (2013) The rising tide of diabetes mellitus in a Chinese population: a population-based household survey on 121,895 persons. Int J Public Health 58:269–276. doi:10.1007/s00038-012-0364-y

    Article  PubMed  Google Scholar 

  • Yehya N, Dutta M (2010) Health, religion and meaning: a culture-centered study of Druze women. Qual Health Res 20:845. doi:10.1177/1049732310362400

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The research on which this article is based was conducted as part of MedCHAMPS, a project funded by the European Commission under the Framework 7 Programme (Grant No. 223075). We would like to acknowledge the contribution of Professor Julia Critchley, the Scientific Coordinator of MedCHAMPS.

Author information

Authors and Affiliations

  1. CVD Epidemiology and Prevention Research Laboratory (CAVEPLA), Faculté de Médecine de Tunis, Tunis, Tunisia

    Faten Tlili, Afef Skhiri & Habiba Ben Romdhane

  2. Institut National de Santé Publique (INSP), Tunis, Tunisia

    Faten Tlili

  3. Department of Sociology, Université de Sfax, Sfax, Tunisia

    Francine Tinsa

  4. Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK

    Shahaduz Zaman & Peter Phillimore

  5. School of Geography, Politics and Sociology, Newcastle University, Newcastle upon Tyne, UK

    Peter Phillimore

Authors
  1. Faten Tlili
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Francine Tinsa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Afef Skhiri
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shahaduz Zaman
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Peter Phillimore
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Habiba Ben Romdhane
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Peter Phillimore.

Additional information

This article is part of the supplement "The rising burden of noncommunicable diseases in four Mediterranean countries and potential solutions".

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tlili, F., Tinsa, F., Skhiri, A. et al. Living with diabetes and hypertension in Tunisia: popular perspectives on biomedical treatment. Int J Public Health 60 (Suppl 1), 31–37 (2015). https://doi.org/10.1007/s00038-014-0572-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00038-014-0572-8

Keywords

search

Navigation