Global Health and Cancer An Ethnographic Study of Barriers to Cancer Pain Management and Opioid Availability in India

Background. The world’s global cancer burden disproportion-ally affects lower income countries, where 80 % of patients present with late-stage disease and have limited access to pal-liative care and effective pain-relievingmedications, such asmor-phine. Consequently, millions die each year with unrelieved pain. Objective.The objective of this study was to examine barriers to opioid availability and cancer pain management in India, with an emphasis on the experiences of nurses, who are often the front-line providers of palliative care. Methods. Fifty-nine participants were recruited using a pur-posive, snowball sampling strategy. Ethnographic data collec-tion included in-depth, semistructured interviews (n 5 54), 4001 hours of participant observation, and review of docu-ments over 9months at a government cancer hospital in Sout