Salimah Meghani

I began my Nursing career in Pakistan-- a developing country of South Asia. As a nursing student in a baccalaureate program in Pakistan, I was distressed by the problem of unavailability of opioids for cancer pain relief and witnessed many of my own patients dying a horrifying painful death due to a lack of availability or a total unavailability of morphine and other opioids for medical use. This is despite the fact that over 80% of patients in Pakistan are diagnosed with cancer when palliation and pain relief remains the only practical option of cancer management.

During my bachelor's studies in Nursing in Pakistan, I stumbled on a pleasant opportunity to work with a Palliative Care Specialist from Canada, who came to our university as part of a bilateral program between the Canadian International Development Agency and the Government of Pakistan. My ongoing interactions with this professional helped me develop tremendous insight into the need and scope of palliative and end-of-life care for cancer patients.

Unfortunately, this knowledge came with a great deal of frustration. Until 1999, there were no formal palliative care/hospice care programs in Pakistan, the stringent narcotic legislation in the country made it extremely difficult for patients to obtain morphine for cancer pain relief. I wanted to systematically research and understand the problem of unavailability of opioids for medical use but that opportunity was also not available due to lack of advanced educational and research opportunities for nurses. Bachelors in nursing (BSN) was the highest credential available to nurses in Pakistan, which too was offered at only one institution (i.e., the Aga Khan University) in a country of 148 million people.

This frustration prompted me to pursue higher education in nursing. I migrated to the United States in the fall of 1999 and started my Masters in Nursing at University of Pennsylvania and then went on to pursuing a PhD in Nursing and another Masters in Biomedical Ethics (MBE) at the same university. Here I had the invaluable opportunity to work with great scholars who helped develop a vision of nursing from a global perspective. As a scholar at Penn, I got the opportunity to network with professionals, policy makers, and researchers not only in the U.S. but in other nations confronting the issues of lack of opioid availability for cancer pain relief. I learned the true essence of what global village means-- that the world is a small place after all. One does not have to be physically present within any geographical boundaries to study or influence a policy change.

In the U.S., I became intrigued by the problem of a general under-treatment of pain that occurs despite the fact that the U.S.'s tremendous capacity to manage pain. While under-treatment of pain is a general public health problem, a plethora of studies suggest that minority race/ethnicity is independently associated with under-treatment of pain. Thus, I embarked on a doctoral dissertation to understand 'Factors Affecting the Negotiation of Treatment for Cancer Pain among minorities'. The goal of this study is to better understand the complex social, cultural, and health system factors that impede appropriate and effective cancer pain treatment among racial/ethnic minorities.

As a minority in the US, I have developed a unique blend of perspective that will help me develop a culturally appropriate model of cancer pain relief for minorities in the US. At the same time, my humble legacy, as a person from developing a country, compels me to extend the boundaries of my research and practice to improve care of the less-privileged in destitute nations. The NEF Scholarship is invaluable in advancing my research and career goals at this time and will help me in developing a research trajectory towards minimizing health care disparities from a global perspective.