Ashley, a flight nurse with eight years of experience in neonatal and pediatric intensive care, arrived at CMMB’s volunteer orientation this past May with a calling to serve. Those present that day remember Ashley running from the final session of orientation, backpack in hand, to catch the first flight of her long journey to South Sudan. Her excitement, anticipation, and commitment were palpable.

Fast forward to today and Ashley has been in Nzara, South Sudan for over a month, supporting the delivery of care at St. Theresa Mission Hospital. In the Q&A below, she reflects on these first weeks as a volunteer nurse and dives into the realities of healthcare in her new community.

What are your first impressions of Nzara, South Sudan?   

I assumed the hospital would be just a few buildings, but it’s much bigger and more complex. Although the staff’s medical knowledge is basic, some of the team members have blown me out of the water with their dedication and hunger to learn.  

I spent the first month immersing myself in life here and trying to understand how the hospital functions. It’s very tricky to balance clinical work alongside capacity building—it’s one of our biggest challenges here. But Benson, the hospital director, has led incredible progress at the hospital. He is our biggest supporter, and I really enjoy working and learning with him. I trust him and he trusts us.  

One thing that truly surprised me about working at the hospital is how equipment is managed. There are a lot of broken tools that we are slowly cleaning up or trying to fix. With help, we have fixed some of the equipment—tripling the hospital’s supply of oxygen as a result!  

Ashley Munoz trains a health worker at St. Theresa Hospital in South Sudan

Can you describe the patient experience at the hospital?  

It’s completely different than back home. Patients are responsible for their entire wellbeing outside of receiving medical care, including the provision of food, and they rely on their families for basic support.   

Because of pressures to care for family members at home, most can’t afford to stay in the hospital for more than a few days. This has been a learning curve for me, especially when caring for premature babies who should be in the hospital for upwards of two months. I have started teaching these new mothers how to do continuous Kangaroo Care, skin-to-skin contact between mom and baby, at home. I ask them to come back to the hospital for weekly to bi-weekly follow-ups but not all do or can.  

Some people in Nzara still rely heavily on traditional healers. They will leave the hospital to go to their traditional healers and come back even sicker. The society here is also very patriarchal. Very few mothers feel comfortable taking their children to the hospital alone. Sick pediatric patients often come too late because their fathers were away at the farm or working. 

What has been your hardest moment as a volunteer so far?  

I’ve had to send babies home, knowing that they won’t survive. I’ve had to watch others die before they even have the chance to go home. These are the hardest moments.  

I minored in bioethics, but every day here I make some of the most challenging ethical decisions I have ever had to make. They are so much more raw and real than one could imagine. On one occasion, I was asked if we should do chest compressions on a severely malnourished child who was in the last stages of death. I knew that if we did chest compressions on this child, his ribs would break, and his last moments would be filled with pain instead of peace. Sometimes, all I can give patients here is a peaceful death. 

How do you get through these moments of loss?  

We had an older gentleman come to the hospital after having a stroke the week before. He continued having seizures on and off, until we finally got them under control. A few days later, he was still weak but stabilizing. Sadly, he was not getting enough nutrients through the feeding tube. By the time we realized this, it was too late. He passed that same afternoon. It’s very difficult to lose a patient when you know you could have saved them with the right resources. Very few people cry here, but this family did. This man was beloved. Despite the tragic circumstances, he passed peacefully. In the ICU especially, not all deaths are peaceful. I have witnessed a lot of suffering. A peaceful death surrounded by loved ones is a gift.  

 The miracle of life and death here get me through those hard moments. I believe in life after death and so much of the community here does too. Every day in Nzara, I look around and simply marvel at the miracle of life. I see children playing and I feel gratitude.   

Ashley Munoz with a new mom and her husband.

What do you hope to accomplish as a volunteer?  

A friend offering encouragement recently shared the age-old story of a fisherman. This fisherman was walking on the beach, throwing back a starfish into the sea that washed up on land. When asked why he was wasting his time doing that when there were thousands of other starfish on the shore, he said: “Because I am saving this one starfish.” 

I can’t save everyone, but I want to save those I can and those that are in front of me. I also need to help create systems and build capacity to help the staff continue saving lives after I leave. I want one thing or system I make to last beyond me. I don’t know what that will be, which is why I am working hard to plant as many seeds as I can in the best soil I can find. God will do the rest in his own time and way. 

Ashley Munoz and Mahvash Majeed with hospital staff

What else do you want people to know about your experience?  

Working in South Sudan is some of the hardest work I have done. The work is so challenging because we are trying to balance sharing our expertise while creating sustainable systems to support our colleagues. Thankfully, we work with some incredible team members and receive lots of support ourselves.  

We want to encourage more volunteers to come! We need non-medical volunteers as much as medical volunteers. We need engineers, people to write protocols, people to create inventory systems, people to teach everything from computer skills to quality control and infection prevention. We even have work for a legal professional here!