In the serpentine valleys of Sikkim, where prayer flags ripple against snow-clad peaks and reaching a health facility can take hours, a quiet shift is underway in how communities understand life after cancer. The Cancer Survivorship Program under Cancer Care Bharat has given healthcare workers here a new lens, one that sees beyond the end of treatment and into the long, often unseen journey of recovery.
At the Phongla Health and Wellness Center in Namchi, South Sikkim, Kesang Diki Bhutia recalls how she once defined survivorship. “It is the care given to a patient after the treatment and when the patient is completely cured from the disease,” she says. That understanding changed when she joined the program in April 2025.
“The program helped me understand that care isn’t just about treating the patient, it’s about involving the family and the community. Counseling is crucial. That was something I didn’t focus on before,” she explains. One case stands out vividly. “There was a patient in my area recently diagnosed with stomach cancer. He was very depressed and didn’t believe he could continue his daily activities. After the sessions, especially the ones on counseling, I spoke to him. He was surprised that I took the time to understand what he was going through. He had assumed treatment only meant medication. But through our conversations, he started to feel lighter and understood the importance of emotional and mental health support alongside medical care. He even asked for more counseling options.”
Kesang now sees care as something much larger. “Care should be holistic. Not just patient-centred, but family- and community-oriented as well.” Her approach includes training her team of health workers and ASHAs in survivorship principles so that regular home visits and community involvement become routine.
Two hundred kilometres away, in East Sikkim, Kritana Chettri began the program with an equally limited view. “Before enrolling into the program my knowledge regarding cancer survivorship was quite narrow. It was often seen to me as basic follow-up care focused on scheduling routine check-ups, monitoring for signs and symptoms of recurrence, managing immediate side effects, and referral,” she says.
A session on psychosocial aspects was a turning point. “There was a session that really stayed with me where it was said, ‘Survivorship is the beginning of a new chapter.’ That was an eye-opener. It helped me understand that for cancer survivors, life after treatment isn’t about going back to their old selves. It’s a completely new journey, one with mental health challenges, body changes, social shifts. Psychosocial care is essential, and I now understand the survivor’s emotional and spiritual needs better.”
Her daily practice changed immediately. “Earlier, I focused only on the physical aspects. Now I actively ask patients how they’re doing emotionally and socially. I help them connect with survivor groups, offer helpline numbers for mental health, and ensure they don’t feel alone or like a burden to their families.”
For Kritana, the lessons became personal when she applied them to a relative. “A family member of mine had breast cancer. From the outside, it seemed like she was fine after treatment. But inside, she was battling fear, fatigue, and guilt. After this training, I approached her differently. I validated her feelings, helped her connect to helplines, and involved the family in her care. It made a huge difference in how supported she felt.”
She also began addressing long-standing challenges. “Many patients didn’t follow up post-treatment, thinking they were cured or fearing more bad news. Financial constraints were also a big reason. After training, I now guide them on low-cost options, help them access government schemes, and connect them with higher centres and teleconsultation services.” To strengthen this work, she formed a small team. “Every two weeks, they conduct home visits to follow up with survivors. We use teleconsultation more efficiently, and team members from the same village are more involved in outreach.”
In Martam, Gangtok, Ripla Namapa entered the program with her own assumptions. “Survivorship in my point of view was a patient who has been recovered completely from cancer,” she says. Now she defines it as “continuum of care, counselling to family members and care providers, palliative care to the patient, and regular home visits.” She recalls a patient on palliative chemotherapy. “I did frequent home visits and called them on the phone. I mobilised ASHAs. They responded well.” The main challenge she sees is the “loss of hope to live, that they think themselves as a burden.” She addresses this with counselling and education.
From the outset, the program was designed to change these perspectives. Dr. Maya Silal, Director of Health Services for the National Health Mission in Gangtok, reflects on the early days. “It began on April 3, 2025. Honestly, survivorship was a new concept for us. Earlier, once treatment ended, patients were left to manage alone. We hoped this program would help our MLHPs support survivors more holistically. They’re closest to the community and can truly make a difference.”
The results, she says, have been clear. “Initially, they were hesitant. But now they’re more confident and engaged, asking insightful questions and eager to learn more. For example, we had a lung cancer case where immunotherapy was discussed. We don’t yet have it in our state, but now we’re advocating for it, thanks to the knowledge shared through this program.”
Across Sikkim, these changes are creating a ripple effect. Survivors who might once have felt abandoned after treatment are now being met with empathy, guidance, and consistent follow-up. Families are being drawn into the circle of care, community members are part of the healing process, and healthcare workers are treating the whole person, not just the disease.
As Kesang says, “Care isn’t just about the patient, it’s about the family, the community, and the journey after treatment.” In the mountains of Sikkim, that journey is now filled with more than medical appointments. It carries conversations that lighten the spirit, networks that share the load, and a renewed belief that survivorship is not just surviving cancer, but rebuilding life in all its dimensions.