Most of the stories about Central American migrant children coming to the U.S. in recent years have been sad ones. That’s especially true of Guatemalan children. Since December, three Guatemalan minors have died while in U.S. immigration custody – including a 16-year-old boy in Texas this month.
Which is why Mayra Pedro Andrés’ story matters.
Mayra is a two-year-old indigenous Guatemalan girl. She has a bright, mischievous smile and a gregarious personality. And, until now, she had an extremely rare medical condition.
You wouldn’t have noticed it watching Mayra in her new home near Lake Worth, Florida, last month – playing with blocks, wearing a black velvet dress. But beneath it, Mayra’s stomach had two surgically created colostomy holes for going to the bathroom.
That’s because Mayra was born with cloaca. She didn’t have an anus, a urethra or a functioning vagina. This kind of malformation is thought to occur in only 1 in every 50,000 children. It’s frightening enough to be born with the cloaca defect in a developed country like the U.S. But in poor, rural Guatemala, the blockage of Mayra’s urine and feces looked like a death sentence.
“When I saw what was wrong with my baby girl I felt like I’d done something terrible to her,” says Mayra’s mother, Candelaria Pedro Juan, weeping at the memory.
Candelaria was 22 when she gave birth to Mayra in their village in Guatemala’s northwest Huehuetenango province. She and her husband Mateo were at a particular disadvantage finding medical help for Mayra because they’re indigenous Akatek Maya who don’t speak much Spanish.
As a result, says Candelaria, “We spent weeks looking for emergency doctors who could do something, anything for Mayra.”
They finally found doctors in Huehuetenango who solved part of the problem. They created the colostomy holes and connected some of Mayra’s intestines and urinary tract to them. But they warned Candelaria that Mayra could likely die soon of problems like infections and kidney failure.
The only solution was major surgery to build Mayra’s missing anatomy – an operation that wasn’t available in Guatemala.
"She was dying. That’s why I told them to come here,” says Candelaria’s younger sister, Petrona Pedro Juan.
Huehuetenango’s drought crisis forced Petrona to migrate to the U.S. five years ago – when she didn’t speak a lot of Spanish, let alone English. Now she attends community college in Massachusetts – and, emboldened by her own success, she wants Mayra to have similar opportunities.
“She’s my niece, y’know?” says Petrona. “I freaked out and I said, ‘No, you cannot let the baby die. She has, like, long to live. I’m sure she can get better.’”
She convinced her sister to bring Mayra to the U.S. for cloaca surgery. They weren’t aware of possible emergency medical U.S. visas. So last summer, with money donated from family and friends, Candelaria and her baby traveled to the U.S. border.
That hot, dusty journey was doubly difficult because each day Candelaria had to find special bags to keep Mayra’s colostomy holes clean. But as they were about to cross into San Diego and ask U.S. border officials for asylum, Candelaria froze:
I suddenly thought, What if the border officials see Mayra's condition and don't let us in? Then the nurses in Texas gave me information for taking care of Mayra that I couldn't get in Guatemala. That's when I knew I was right to bring my baby here. –Candelaria Pedro Juan
She decided to keep it hidden while they were in migrant detention. She didn’t let nurses see it until they were in a migrant shelter in Texas and were given a temporary green light to join Mateo, who had migrated here to Palm Beach County months before to secure them a place to live.
Those migrant shelter nurses in Texas helped Candelaria in ways we don’t often hear about these days when it comes to U.S. immigration custody.
“They gave me information for taking care of Mayra that I didn’t get in Guatemala,” Candelaria recalls. “That’s when I knew I was right to bring my baby here.”
In Lake Worth, Mateo had gotten work in landscaping and was sharing a small house with two other migrant families. Candelaria’s sister Petrona came to help care for Mayra. But they still had to find the funds – about $200,000 – for the surgery to create an anus, urinary tract and vagina for baby Mayra.
Enter the Guatemalan-Maya Center in Lake Worth.
“I am very grateful that God provided me the opportunity to just be in the middle – to connect the dots,” says Amanda Escalante, a coordinator at the nonprofit center that aids migrant families.
Escalante spent months reaching out to foundations here and abroad. Then, earlier this year, an anonymous donor stepped up to pay the full cost of Mayra’s cloaca surgery.
“I’m still in shock,” says Escalante. “But I never lose hope in humanity. I had admiration for the way Candelaria cared for the child. And nobody can meet Mayra and not feel the same thing that I felt.”
GOING TO THE MOON
Perhaps the person most smitten by the toddler was the Guatemalan-Maya Center’s director, Roman Catholic priest Father Frank O’Laughlin. Mayra in fact now calls him abuelito, or “grandpa.”
Even before the donor emerged, O’Laughlin was in talks with South Florida hospitals urging them to take on Mayra’s surgery. He says one of his strongest talking points was Candelaria’s courage.
“This woman will climb mountains and swim rivers to get her baby there,” he says.
Pediatric surgeons at Nicklaus Children’s Hospital in Miami soon started prepping Mayra for what is considered an especially complicated surgery. O'Laughlin spoke regularly with the doctors as he tried to help Candelaria understand the overwhelming array of anatomical scans and sketches they presented her.
“The sense you get form talking with them is, heh, we’re goin’ to the moon,” says O’Laughlin. “But the doctors can restore each function. She’s going to be able to use the bathroom both ways, and she’s going to have reproductive function – which is astonishing.”
The doctors at Nicklaus performed the first of Mayra’s two surgeries late last month.
The operation was a success. You can see that – evidenced by Mayra’s rambunctious post-op play with volunteer students from Immaculata-La Salle High School in Coconut Grove – who come to Nicklaus each day to help take care of Mayra because in Candelaria recently had a baby boy, David.
One of Mayra’s favorite activities is learning English. She rifles through crayon canisters calling out one color in English after another as her baby brother watches her wide-eyed, wrapped in a shawl on his mother’s back.
All of that gratifies Dr. Juan Calisto, who leads the Nicklaus surgical team. Because cloaca involves not just reconstructing anatomy but constructing anatomy, Calisto says, “the malformation that Mayra has is probably the most challenging a surgeon can repair.
“But it’s not about just the surgery. It’s her whole life. Her growing up; having kids later in life. It’s what we’re passionate about.”
The Peruvian-born Calisto, who is also part of Nicklaus’ colorectal team, is a veteran of cloaca surgeries – and he has high praise for how well Candelaria prevented Mayra's condition from deteriorating amid their impoverished circumstances, a factor that made the surgery less daunting.
Calisto often performs cloaca surgeries in Latin America because so few doctors there are trained to do them.
“A moral obligation we have in the U.S. is to go to these places and teach the surgeons how to do it,” he says – so children like Mayra won’t have to journey to the U.S. to survive.
Mayra’s last surgery is set for next month. Her parents hope to fix their immigration status so she can stay in the U.S. At two years old, she’s made this her adopted country – and makes sure departing visitors to her hospital room know it when she tells them “bye-bye” in flawless inglés.