The pain started while Miriam Orta pushed carts as a hotel housekeeper in Woodbury, Minnesota. She found the sudden aches in her back and shoulder surprising: Orta had worked as a welder in Colombia and her native Venezuela without incident and just survived a grueling journey to America seeking asylum.

She was scared to go to the doctor — she had no health insurance. When Orta finally went to La Clinica in St. Paul, Minnesota, a doctor diagnosed her with breast cancer.

Orta, 39, returned to the hotel where she and her girlfriend, Liseth Juarez Valera, 45, worked.

“I struggled so much to get here, and now I’m getting sick,” Orta said.

“After all the trek we had just done ... I’m going to die.”

The women had known one another since they were girls in Venezuela and their fathers did repair jobs at one another’s homes. (They agreed to tell their story on the condition that only their partial names be published as they seek asylum.)

Orta liked that Valera spoke her mind, saying “She was an extrovert and spontaneous.” Valera admired that Orta’s welding job was one that women usually didn’t do. “She seemed very tough,” Valera said.

They became a couple in 2020 but kept their relationship a secret; being openly gay can be dangerous in Venezuela, where same- sex marriage is illegal.

The following year, Valera’s brother migrated from Venezuela to St. Paul after facing threats for not following orders in the military and disagreeing with President Nicolás Maduro’s politics. Her brother reported that as difficult as it was to find a job and not speak English, it was still easier than life in Venezuela. He secured temporary protected status. Valera and Orta started their journey north in February 2024, joining hundreds of thousands of other Venezuelans fleeing political repression and economic hardship.

The couple journeyed in the rain through the Darién Gap, the perilous jungle region linking Colombia and Panama. They took buses, paid guides and walked across Central America. Along the way Orta and Valera pretended they were sisters, scared of retribution if they said they were in a relationship. In Mexico, Orta took a job in construction when they ran out of money, defying the crew’s reluctance to hire a woman.

They followed the Biden administration’s instructions that migrants turn themselves in at a port of entry by making an appointment through the CBP One app. Last July, Orta and Valera entered the U.S. After they were photographed, fingerprinted and questioned, they were approved for work permits and given a notice to appear in immigration court.

Upon arriving in St. Paul, they stayed with Valera’s brother, his wife and child for a month. He lent them money to rent a place of their own. He also bought them a used car so they could work as DoorDash drivers until they found steady jobs. To furnish their new home, Orta and Valera found a couch on a curb and loaded it into the van. Someone donated a bed.

The couple quickly found jobs in Woodbury as hotel housekeepers for $16 an hour.

Then came the cancer diagnosis — months after the couple arrived in their new country. Orta was scared to hear the doctor say the word mastectomía.

Through La Clinica she met Julissa Rios, a longtime case manager at the clinic. Rios applied on Orta’s behalf for Emergency Medical Assistance, a longtime state program that covers cancer treatment for low-income undocumented immigrants. EMA provides coverage for those whose immigration status would otherwise bar them from accessing similar services under Medicaid, but it does not cover reconstruction, physical therapy or follow-up appointments.

“I think God put her in my path,” Orta said of Rios. “I was very worried because everything that they were doing on a medical level, I didn’t think I could afford it, and she eased that worry in me and said she’s going to do everything possible to help out.”

Valera keeps photos of Orta getting ready for the October operation at Regions Hospital. She’s wearing a white tank top, then a hospital gown, sitting on the bed. The surgery to remove Orta’s left breast was successful. The cancer, discovered in its early stages, was gone.

Rios invited Orta to a support group, La Nueva Esperanza, which brings together immigrant cancer survivors once a month in a basement room at La Clinica. At first, Orta found it difficult to open up. Yet the more she spoke, the easier it became.

“It’s been a good place for me to get that kind of support from people who are going through the same thing,” Orta said.

At La Nueva Esperanza, Orta was moved by the words of a Mexican immigrant named Juanito. He said God — not the doctor — will tell him when his life is over.

Juanito, a 14-year McDonald’s employee, has undergone numerous rounds of chemotherapy since 2019 — treatments that his insurance didn’t cover.

“I feel better when I’m there because sometimes it’s nice to talk to others. I’m alone all the time here,” said Juanito, who asked that his last name not be published because he’s lived in the U.S. without legal status for two decades.

Juanito said it was the support group members’ laughter that helped him the most.

Rios founded the support group 20 years ago after seeing newly diagnosed patients asking for help. They had no health insurance, and because they often lacked legal status, they did not qualify for most resources. Rios started collecting information, distributing welcome kits and helping them apply for Emergency Medical Assistance.

She noted that migrants may carry trauma that inhibits their treatment: Some women who were raped on their journey to the U.S., for instance, are afraid to get a Pap smear to monitor for cancer.

The group talks about immigration lawyers, vaccines, nutrition and exercise. Rios has observed that members are wary of discussing depression. She said it’s taboo in Latino culture, and people don’t want others to know they are suffering.

At the group’s Thanksgiving party, one of the prizes was an engagement ring. Valera raised her hand and told Rios that she wanted it.

She proposed to Orta in front of everyone, and Orta said yes. They held the ceremony this year at a meeting of the support group.

“They decided to try, like many of their fellow Venezuelans, to immigrate to the United States to take a new chance at life, a new hope,” Rios told the gathering.

Orta and Valera know that their troubles are not over. They are working with an attorney on their asylum case; their first court date is in November. They’re still trying to make a living: Orta now works as a cook at a day care, while Valera picked up shifts at a tortilla factory.