When Josephine Maina was diagnosed with breast cancer, finding treatment in Kenya wasn’t her biggest concern. Instead, it was finding pain relief drugs and doctors willing to prescribe them. "I went to three doctors,” Josephine says. “None of them would give me medicine for my pain.” Across the developing world, palliative care has long been neglected as a global health priority. And today, as the United States is battling an opioid addition crisis, an estimated 5.5 billion people – or 75 percent of the world’s population – lack access to adequate pain relief. Though the World Health Organization defines opioid analgesics as essential medicines, 85 percent of the world’s population accounts for just 7 percent of the global annual use of pain medication. In comparison, the U.S.’s 4.9 percent of the population consumes 80 percent of its opioids. Yet low and middle-income countries with scant resources dedicated to pain management constitute 70 percent of cancer deaths and 99 percent of HIV/AIDS deaths, two of the most common illnesses that result in intense end of life pain.

In Kenya, an estimated 51,000 of cancer and HIV/AIDS patients spend their last months in moderate to severe pain and in 2012, less than 10 percent of these patients were treated with adequate pain medicines. Though the country is considered a regional leader in palliative care, it is plagued with many of the same issues as its neighbors: the complete absence of pain treatment training in medical curricula until 2012, doctors’ subsequent hesitance to prescribe opioids, laws prohibiting nurses – the overwhelming majority of medical practitioners in rural areas – from prescribing opioids, and the cultural stigma attached to seeking palliative care and pain relief treatment. Since Josephine Maina was diagnosed twenty years ago, the country has established 17 pain management centers, though these hospices only reach a fraction of those in need of pain relief care. Josephine works as a community volunteer in one of these centers which, along with three others, have offered access to their patients have offered access to their patients, home based-care programs, weekly support groups, and center-based services for this story. In recent years this issue has received increased recognition and in April, the U.N. General Assembly held a Special Session on “the world drug problem.” It was the first time the UN has met in General Assembly on this issue since 1998.