Multiple myeloma, unequivocally, poses a diagnostic dilemma to health care providers in a developing country such as Nigeria. Currently, there are three strategic challenges in managing multiple myeloma in the region and these are awareness, diagnostic, and therapeutic challenges. The consequences are poor case ascertainment, increased complications, late diagnoses, inadequate palliative interventions, and low survival outcomes of people living with multiple myeloma in the region. The strategic palliative leadership approach uses the leadership theories, styles, models, drivers, and operations to facilitate personal, institutional, and community behavior-change to attain an effective level of palliative care of people living with multiple myeloma. However, this is a far cry from what is obtainable in a developing country such as Nigeria. This case study is a practical update of challenges encountered in diagnosis and therapeutic care of multiple myeloma individuals in resource-poor settings where there are dearth of data and facilities for effective palliative care.