Sen. Rand Paul uses surgical skills in Guatemala; Citizens United founder brings film crew along

The Washington PostAugust 22, 2014 

SALAMÁ, GUATEMALA — Brothers Juan and Andres Hernandez traveled more than four hours here by bus for the chance to reunite with the man they call "Dr. Pablo."

Fifteen years ago, the two of them were flown to Bowling Green to be examined by a local ophthalmologist named Rand Paul. Fifteen years ago, Paul had no political aide or press secretary, there was no 13-hour filibuster, no talk of a possible presidential campaign. No bodyguard named Axel.

Since operating on the Hernandez brothers in 1999, Paul has become the junior senator from Kentucky and a prospective Republican presidential candidate.

He came face-to-face again with the brothers this week at a local hospital. The meeting happened in front of three television cameras, three photographers, six reporters, a political aide, two press secretaries, conservative activist David Bossie — and Axel, watching closely.

Paul started speaking Spanish he'd learned as a kid growing up in Texas. Taking out a pencil light, he examined the brothers' eyes.

"Mire la luz," he said — look at the light. Paul handed Juan his glasses and asked him to try them on. He asked him: Is your vision better or the same with the glasses?

"No difference," Hernandez said in Spanish. After a few moments, Paul said he wanted the brothers to visit a nearby clinic for a thorough exam. Then he asked them to pose for a picture.

"Smile!" someone shouted. The brothers stared ahead, seemingly unable to comprehend the political implications of their photo.

Announced a few months ago, Paul's trip to Guatemala came at a time when other Republicans considering presidential campaigns, including Rep. Paul Ryan, R-Wisconsin, are talking more openly about a "compassion agenda," finding ways to help the poor and less fortunate. Here, before the cameras in Salamá, Paul was on that terrain — but a world away from the rest of a GOP presidential field dominated by career politicians.

The stage-managed political voyage exposed logistical shortcomings by its organizers — and the clear ambitions of the man at the center. But it also revealed a rarely seen side of a closely watched figure, a careful surgeon quietly operating in a chaotic environment. Someone who at times appeared detached from his grateful patients, but who clearly relished a rare opportunity to discuss the details of modern medicine and politics with other members of the surgical team.

Paul said he simply wanted some time to practice medicine again. He is licensed to treat patients in Kentucky, where years ago he established his own certification board after a dispute with another governing body for ophthalmologists. He's performed pro bono surgery for years in his home state but had long wanted to join a medical mission overseas.

"The reason we're here is to try to help people," he said in an interview between surgeries this week. "It's something I spent a long time learning to do. It really is my passion — medicine and doing surgery." Plus, he said: "I'd hate to give up a skill that I spent a long time learning to do."

But David Bossie's presence cast aside any doubt that the trip was merely an opportunity for the senator to reconnect with his medical roots. Bossie is the founder of Citizens United, the group that successfully sued and prompted the U.S. Supreme Court to rule that corporations and labor unions can spend unlimited funds on direct advocacy for or against political candidates. A documentary maker who has shadowed Paul before, he traveled here with his daughter and a film crew equipped with lights, cameras and an unmanned aerial drone for overhead shots. Bossie said little about his plans, other than that his footage would appear in a forthcoming film either about Paul or an issue of importance to him.

Paul and his aides refused to say how much money he spent on the trip. But the senator said he had asked several political donors, including Donald Trump, to donate to the John A. Moran Eye Center at the University of Utah, which made most of the logistical arrangements and shipped medical equipment into Guatemala. Another group from Utah, Hope Alliance, also helped cover expenses and operated a clinic that distributed about 8,000 pairs of glasses to local residents.

Aides stressed that no taxpayer money had been spent to secure or transport the senator. Security was provided by members of Guatemala's presidential security detail. In addition to Axel and other plain-clothes bodyguards, officers with the Guatemalan National Police patrolled the senator's hotel and the sites where doctors operated.

Paul was among roughly 70 Americans who traveled to Salamá. While Hope Alliance worked on distributing eyeglasses, a team of surgeons, nurses and technicians from the Moran Eye Center performed cataract surgery on at least 200 patients over five days.

The lack of care, poor nutrition and the infrequent use of sunglasses here made cataracts seen this week larger and harder and more difficult to extract, surgeons said. Some cataracts were the size of corn kernels. Others looked like chocolate chips.

In an operating room inside the local Lions Club clinic, Paul and the other surgeons operated in a brightly lit, white-tiled room not much larger than an urban apartment kitchen. Working on hundreds of patients over five days required careful coordination, so in order to streamline the process, one table was for left-eye patients, another for right-eye patients.

Paul wore blue surgical scrubs, hiking boots and a red surgical cap. He partnered on Monday with David Chang, a leading ophthalmologist, the past president of the American Society of Cataract and Refractive Surgery and a clinical professor at the University of California at San Francisco. Chang's textbooks on cataract surgery have been translated into Spanish to help instruct Latin American surgeons.

After scrubbing in and suiting up, Paul turned to the surgical table to review the phacoemulsification machine, a device that he manipulated with a pedal below his left foot. With a slight tap, he applied the pressure needed for the tools in his hands to extract a cataract and implant a new lens.

"We have almost no space here," Paul said as he asked one of the nurses to help him adjust the operating table. An air conditioner whirred as Aerosmith's "Sweet Emotion" and the Rolling Stone's "You Can't Always Get What You Want" played softly. The senator kept mostly quiet as Chang observed Paul's work on a patient, sometimes offering suggestions. "Go on the other side," he said at one point. "Sometimes you can dig in and spin the lens a little bit."

The surgeons, nurses and technicians said that they had dealt with some of the most complex cases of their career here.

"The type of cataracts that we see here, they're very challenging for me," Chang said. "They would really challenge the vast majority of American cataract surgeons, simply because they're so advanced and the eyes have a whole host of other problems."

Other surgeons said Paul eagerly tackled some of the most complex cases.

"He's dived in on a few of the tough ones, and he's doing okay," said Alan Crandall, vice chair of ophthalmology and visual sciences at the Moran Eye Center.

Performing surgery is exhilarating, the surgeons said. But "The morning after" is what makes ophthalmology so special.

"If you don't like the morning after, then you're just a technician. You're sort of more of a robot than a human," Paul said.

When patients arrived Tuesday morning to have their bandages removed, smiles broke out across the waiting room. An older man jumped to his feet in excitement and hugged a surgeon.

Scanning the room, Paul gave a clinical assessment: "Some of them, they'll be able to see better as the day goes on," he said, adding later: "We were commenting that not many of them were smiling yesterday, but we got a few smiles today."

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