The introduction of biomedicine to Sikkim provides a number of contrasts to the rather ad hoc processes that occurred in the Kalimpong- Darjeeling and western Himalayan areas. The Buddhist state's reluctance to admit European missionaries into its realm restricted their influence on medical development in Sikkim. Missionary medicine was still a significant force in the first two decades of British rule, and Kalimpong- trained local staff played a major role in spreading biomedicine from the dispensaries there. But the missionaries were not able to dominate medical initiatives in this Himalayan state as they had in Kalimpong. Instead it was the Indian Political Department's appointees, the Sikkim Political Officers and their medical staff, who played the key role.

Sikkim was, however, primarily of importance to British India as the gateway to Tibet, and little finance – or effort – was devoted to developing it. Under the Princely state system, Sikkimese medical developments were largely funded from state revenue and the medical officers posted there were not of the highest status. But Sikkim did in many ways provide a model which the British hoped the Tibetans would emulate, not least in the medical sphere. It was a secure and stable state, where steadily growing numbers of Sikkimese resorted to biomedicine. There was no apparent resistance to the new system, and its structures and personnel were so rapidly indigenised that within two decades of the introduction of biomedicine, Sikkimese medical staff were being employed in British dispensaries in Tibet.

Sikkim, which became the 22nd state of India on 26 April 1975, is situated on the northern border of the Darjeeling district of Bengal. It separates the kingdoms of Nepal to the west from Bhutan to the east, while to its north and north-east is what is now the Tibetan Autonomous Region of China. Lying on the main trade route from Calcutta to Lhasa via the Chumbi Valley, Sikkim today occupies an area of 7,096 square kilometres, ranging in elevation from 300 to 8540 metres. Its highest point is the summit of Kangchenjunga, the third highest mountain in the world, and with much of the territory consisting of steep, jungle-covered inclines or snow-covered mountains, only 20% of its total area is considered habitable.