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, they were flown to Bowling Green, Ky., to be examined by an ophthalmologist named Rand Paul. Fifteen years ago, Paul had no political aide or press secretary. There had been no 13-hour filibuster, and there was 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, in front of a chalkboard where someone had written “Bien vinedos” when they meant to write “Bienvenidos.” The doctor and his patients greeted each other beneath the gaze 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, which he had learned as a kid growing up in Texas. Taking out a pencil light, he examined the brothers’ eyes.

Sen. Rand Paul (R-Ky.) is in Guatemala on a medical mission trip. In this video, Paul, a licensed ophthalmologist, checks the eyes of a patient and converses him via a translator. (Ed O'Keefe/The Washington Post)

“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 (Wis.), are talking more openly about a “compassion agenda,” finding ways to help the poor and less fortunate. Here, before the cameras in Salama, 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.

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.”

(The Washington Post)

But 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 whose lawsuit led 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 filmmaker 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 film either about Paul or an issue of importance to him.

Paul’s entourage included family members and friends; his top political aide, Doug Stafford; and political ad makers Rex Elsass and Rick Tyler, the latter a former close aide to Newt Gingrich. The ad team was joined by a Spanish-speaking colleague who was responsible for trailing behind another film crew with legal release forms that needed to be signed by anyone interviewed or appearing in their footage. It wasn’t clear whether Guatemalans presented with the release forms understood what they were signing.

Stafford was unapologetic about the size or makeup of Paul’s delegation. “There’s nothing wrong with letting people see what he does,” he said. “This is what he’s done with his life.”

Paul and his aides would not 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 to Guatemala. Another group from Utah, Hope Alliance, 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 plainclothes bodyguards, officers with the Guatemalan National Police patrolled the senator’s hotel and the places where doctors operated.

Ahead of the trip, reporters had been promised that they would be able to file reports in real time. But once they arrived, Paul’s aides told journalists — and the doctors, nurses and other volunteers — that any reporting of the trip would be banned while the senator was in town because of unspecified security concerns.

For aides to a senator who is prolific on Twitter, Facebook, Instagram and Snapchat, the blackout meant throwing out their own plans.

Inside the operating room

Paul was among roughly 70 Americans who traveled to Salama. 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 apartment kitchen. Working on hundreds of patients over five days required careful coordination, so 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, 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 and suiting up, Paul turned to the surgical table to review the phacoemulsification machine, which uses ultrasonic waves to emulsify the lens of the eye so it can be safely removed. He manipulated the device 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. “I’d like a couple of more inches.” He worked with the nurses to make adjustments.

An air conditioner whirred as Aerosmith’s “Sweet Emotion” and the Rolling Stones’ “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 S. 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.”

Notably, Paul didn’t smile much. He examined eyes and helped check depth of vision and awkwardly accepted hugs. But he didn’t give many pats on the back or quiet reassurances, as other surgeons did. During a separate tour of the nearby National Hospital, Paul breezed through and greeted surgeons, but he didn’t spend much time bending down to shake the hands of patients. He said later that he’s not a natural retail politician — or surgeon.

He liked shaking hands and meeting people, he said. But “I’m not a huge fan of just, ‘Hey, your shirt looks good. Hey, your shoes look nice.’ Or sort of the empty, vacuous cocktail talk.”

Being a surgeon, he said, is markedly different than being a senator. “In Washington, nothing is ever solved. Nobody can just try to solve a problem and fix it or diagnose a problem and fix it,” he said. “In medicine, there’s not a lot of arguing. . . . For the most part, everyone knows what’s wrong, figures out what’s wrong and moves on to a solution.”

‘Mostly good outcomes’

During the trip, Paul never disputed or dismissed suggestions that he is thinking about running for president. He suggested that potential candidates who aren’t career politicians — in other words, candidates like him — would find favor with most Americans.

“I think that we have plenty of lawyers, we have plenty of career politicians. But the few people who stand out in Washington are the people who aren’t. The doctors, sometimes businessmen,” he said.

In Guatemala, Paul was firmly in doctor mode — showing particular concern for the Hernandez brothers. They had been brought to him in Kentucky 15 years ago — when Jose was 14 and Andres was 8 — by close family friends who had been working in Guatemala for years and who brought especially sick children to the United States for advanced care.

But there wasn’t much more he could do for them. A more intensive exam confirmed that the brothers had never recovered from amblyopia, or lazy eye. Because their condition wasn’t treated before age 7, their brains had never fully corrected the problem. They can see shadows and hand motions but will never have full eyesight.

“There’s no surgery or medicine that will make it better,” Paul told their father after the examination. Turning to a translator, Paul said: “You can tell him that we also tried medicine.”

The father’s face twisted. But Paul’s disposition didn’t change. He looked directly at the brothers and their father. “Vaya con Dios,” he said. Go with God.

Paul said that the setback is just part of being a surgeon.

“You’re privy to a lot of things that other people aren’t,” he said. “Some of them sad, some of them happy. In ophthalmology, mostly happy, and mostly good outcomes.”