Taking a Stand

by Rand Paul

  In 1993, as I came close to finishing my three-year residency, I began looking at ophthalmology practices. I looked at some in North Carolina and one in my hometown in Texas where there was an opening at a large practice. By then, Kelley was pregnant with William, our first son. To be honest, I thought we were going to go to Texas, but I came home one night and saw a look on my wife’s face that told me otherwise. Kelley had talked on the phone that day with her mother, Lillian, and by the time their conversation had concluded, Kelley decided she wanted to go home. Including college, she’d been away for thirteen years. She is very close to her parents and wanted our children to grow up knowing them, especially since they had no other grandchildren nearby.

  Mimi and Papa have been a big part of their lives and ours. I mentioned life’s serendipity earlier, and I can’t think of a better example than what occurred at this time. Had I gone to work in a practice in Texas or North Carolina I can’t imagine where my life would be right now. I’m sure we would have been happy. I’m sure we would have been together as a family. But I’m just as certain I wouldn’t be the United States senator from Kentucky.

  We moved to Bowling Green that summer, just six months after William was born. Kelley’s mom helped find us a brick ranch house that we rented there, only a short drive from Russellville. I loved my work and began to form professional relationships and friendships that have lasted until today. Although I interviewed for a few jobs in larger cities, my desire was always to practice in a small town. I grew up in a small town in Texas just like the one John Cougar Mellencamp sings about.

  Setting up practice in Bowling Green, I knew I could fulfill my small-town dreams. There I would see my patients at church or in the grocery store. I loved being part of a community small enough that most people knew one another.

  I performed cataract surgery but prided myself on doing a variety of operations, from straightening the eyes of children to examining the eyes of premature babies, to plastic surgery around the eyes, to corneal transplants. In a small town, with few subspecialists, I was able to practice many different types of surgeries.

  After a year or so of establishing my medical practice, I became eligible for board certification. I passed both the written and oral portions of the American Board of Ophthalmology exam on the first try, in the summer of 1994. In fact, in each of my three years as an ophthalmology resident, I had passed the written board exams. So when some critics say I’m “self-certified” they often don’t understand the full history of my experience both as a decade-long member of the American Board of Ophthalmology and my subsequent decision not to recertify with them.

  Shortly before I passed my boards and was certified by the American Board of Ophthalmology, the organization’s governing directors voted in a rules change requiring a new recertification exam after ten years—but only for younger ophthalmologists. Even though we had passed the same tests the older ophthalmologists had taken, the new rules exempted them from recertification requirements. The recertification demanded travel to a testing site (I took my initial board exam in Chicago) and payment of test fees every ten years. All older ophthalmologists, or those certified before 1993, were not required to do so to maintain their full certification.

  I organized a protest, along with several hundred other ophthalmologists, against this unequal policy. As a newly minted member of the ABO, I thought it unfair that it was requiring recertification for younger members but not older ones. As you can imagine, the older doctors didn’t quite see it that way and voted to be “grandfathered in”—so as not to be bound under the new rules.

  If anything, it was the older members who were more distant from their training and potentially needed recertification. For example, I worked with surgeons at the time who had taken their boards once, as far back as the 1960s, and were still considered fully board-certified for life, but my certification from 1994 was suddenly only valid for ten-year increments.

  I consider the nationwide protest I led to have been a noble fight. Our protest was met with deaf ears, and so a group of younger ophthalmologists and I formed our own board, the National Board of Ophthalmology (NBO), to compete with the ABO.

  I have always believed that competition raises the level of quality in nearly every aspect of life, and medicine should be no different. After all, the ABO is a private certification group, which has absolutely nothing to do with a doctor’s medical licensure, which is overseen and governed by the state medical boards. This is another point that is often left out by those seeking to deliberately misrepresent the issue. Our group was an attempt to create competition among private specialty certification boards, and had no bearing on state medical licensure or oversight in any way.

  Political opponents and a few of their journalistic allies made accusations that our competing board was comprised of my wife and father-in-law because their names were on the incorporation papers required by the state, but the truth is entirely different. The new board was comprised of talented young ophthalmologists from Boston to North Carolina to Kentucky who weren’t looking for a way to avoid recertification but seeking to have the rules apply to everyone equally, regardless of age.

  For more than a decade, I fought this battle, finally shaming the ABO into requiring that at least the test givers be required to recertify. I took no financial gain from my efforts. The NBO ultimately netted about $20,000, which I donated to the international Orbis Flying Eye Hospital.

  Only in politics could an effort like this be distorted and sullied by opponents with an agenda.

  Another organization that I formed during my nearly twenty years as an eye surgeon in Kentucky was the Southern Kentucky Lions Eye Clinic. A month after I arrived in Bowling Green, I joined the Noon Lions Club, and I worked with them to create a clinic to treat uninsured patients. For nearly fifteen years, I performed eye exams on more than a hundred patients a year, and the Noon Lions Club would help the patients buy eyeglasses. I also performed free eye surgery on patients who came to me through the Lions Eye Clinic. We joined forces with the Children of the Americas foundation to provide surgery for kids from Central America.

  Through Children of the Americas, I operated on several Guatemalan children. Their visits were arranged by Judy Schwank, a friend, attorney, and longtime advocate for adoption. One was a little girl named Juli who was severely cross-eyed. I was able to straighten her eyes. On my recent medical mission trip to Guatemala, I reconnected with Juli. She has grown up to be a beautiful young woman.

  I kept working as an eye surgeon right through my senate campaign and would have kept my practice as a senator too had it been possible. It is against Senate regulations. But I am allowed to perform pro bono surgery, which I do several times a year.

  Long before I took my oath of office for the Senate, I took the Hippocratic Oath, part of which, to my mind, is an obligation to treat the poor. I do believe we are our brother’s keeper, and while government can and should have a role, too much government creates more problems than it solves.

  As my practice grew, so did my family. Three years after William came Duncan, and then, three years later, Robert arrived. Our time became our children’s time. Often it took a logistical miracle for Kelley and me to get three different boys to three different games. We enjoyed countless hours at Kereiakes Park and the Lovers Lane Sports Complex. I coached Bowling Green Little League, soccer league, and basketball. I laughingly say there is only one question I won’t answer about my coaching career, and that’s my win/loss record. Through the years, even before I ran for office, I’d seen much of Kentucky with our oldest, William, who played on various traveling baseball teams. Any part of Kentucky we might have missed we likely saw traveling to soccer games with our middle son, Duncan.

  By the time Duncan was in high school, Kelley was a seasoned soccer mom and team chauffeur. Duncan played four years of soccer at Bowling Green High School, and often Kelley’s car would be filled with Duncan’s travel club and high school teammates. You might not think
that a town like Bowling Green would be diverse, but it is. Many boys on the soccer team were immigrants from Bosnia, Africa, Poland, and Mexico.

  A teammate from Liberia who was only about five feet five could do a bicycle kick over his head and jump as high as a player six feet tall. His name is Exodus, and the story of his name is worth telling. Nine months pregnant and fleeing from the Liberian civil war, his mother walked alone for miles to a camp. On her back she carried the one-month-old baby of a relative. When she gave birth, medical caretakers thought her newborn was dead and put him aside. Hours later, someone discovered Exodus was still warm and breathing where they had laid him—in a pile of other dead children and infants. In a quote to the Bowling Green Daily News about his mother’s decision to give him his distinctive name, Exodus said, “It was basically like saying ‘Let’s get the freedom.’ I guess she thought it was the right name for me.”

  Exodus came to America with his parents from a refugee camp when he was eight years old. When I think about the immigration debate we are having in our country today, I never want to forget that most of us, at one time or another, came to America seeking freedom and prosperity. I think of Exodus and how we need to be a country that is exceedingly proud of immigrants. All of us came from immigrant roots. It’s what makes us the country that we are.

  When I look back at my life—med school, meeting Kelley, starting a family, and establishing a medical practice—I realize what is most important to me. As I travel the nation, spreading a message of freedom and commerce and prosperity, the long hours in airports and on planes and trains can be a draining experience. But the thought of my wife and family always gives me strength. One night on a plane bound for home, I sent this message to Kelley:

  Home is an elusive notion. Its location is not latitudinal but emotional. A GPS will not guide me there but I will definitely know when I am there. I know after a time away, a very short time, I want to be there. As places replace places I have an anchor, a place I know is home. And that promises something nothing can best.

  Home is not just an emotional refuge. Home and family are a civilizing force that binds us together and allows us to succeed. Often people come up to me and lament the loss of family and the brokenness of home and want me to somehow recommend a fix for that. I remind them that some things are outside the realm of government. No amount of government will ever create a home or help mend a broken family. We must turn our gaze from government and look to our families, our ethics and values, our pastors and spiritual leaders.

  3

  Health Care: A Doctor’s Opinion

  It is a noble aspiration and a moral obligation to make sure our fellow man is provided for, that medical treatment is available to all. But compassion cannot be delivered in the form of coercion.

  In August 2014, I accompanied a group of some of the best eye surgeons in the United States to Salamá, Guatemala, to perform much-needed eye surgery for that country’s poor.

  To say Salamá is off the beaten track doesn’t capture the experience. Don’t expect to see a lot of Americans in cargo shorts and Disney World T-shirts if you’re planning a trip there. The tiny village lies in a lush valley eighty-five miles north of Guatemala City, and the road winds treacherously through the mountains. I get motion sickness, so I sat up front, but that vantage didn’t help. Heights are not my cup of tea, so it was less than comforting to be the first to see the areas where the road had collapsed and guardrails were absent. Often just a few stones marked the cliff’s edge. Because of the tortuous nature of the road the trip took nearly three hours.

  Halfway to Salamá we stopped on the top of a mountain at a roadside rest stop. I took a pass on the nachos. My intrepid staff tried them, though, much to their chagrin later that night. The hotel in Salamá was decent and clean but without air-conditioning, and the choice of running water was limited to cold.

  Once we reached Salamá, my courage and appetite improved, and we enjoyed great Guatemalan dishes. Corn is omnipresent. The Maya grow it on the steepest of hillsides, and corn is inextricably linked to their daily life. In the Guatemala creation story the first humans were made of yellow and white corn. It is their sacred staple.

  In Salamá, the operating room was a small, cramped space where we set up tables and equipment. In Spanish, the eye clinic is called the Hospital de Ojos Club de Leones Internationale, which makes it sound far more impressive than the facility actually is. Though immaculately clean, the operating room was tiny and crowded due to the fact that we set up three operating tables where there would typically be only one.

  The Lions Club International has run a sight program for the world’s poor for almost a hundred years, and the tiny clinic in Salamá is part of that program. For me, a longtime Lions Club member, it was like meeting an old friend when the Lions president greeted us wearing the familiar patch-covered vest.

  I was excited to be back performing surgery. I trained for many years to be an eye surgeon, and not only was I returning to my passion, I would be operating with some of the most talented eye surgeons in the United States. It was an opportunity not only to reinforce my skills but to learn new techniques from masters.

  Among those masters was Dr. Alan Crandall, who organized the trip to bring free eye surgery to an area in Guatemala in desperate need of it—there are only two ophthalmologists for every 800,000 people there. Dr. Crandall is the director of the international outreach division at John A. Moran Eye Center of the University of Utah Health Care System, and one of the best eye surgeons in the world. He’s also one of the most giving: he spends two months each year on the road with members of his team performing surgeries in third world countries.

  I would also be operating alongside David Chang from the University of California, San Francisco, a past president of the American Society of Cataract and Refractive Surgery, and Drs. Jeffrey Pettey, Susan McDonald, Roger Furlong, John Downing, and Charles Barr, each of whom occupy a spot at the top of our field.

  The news of our arrival spread quickly. Outside the clinic that first morning the line stretched all the way around the building. Folks had taken hours-long winding bus rides from the hills that surround the Salamá Valley. Sergio Gor, one of my staffers, said the line looked like Black Friday outside a Target store. Few of the Guatemalans, however, could afford such a luxury. The men were dressed in plaid shirts and worn straw cowboy hats, and the women wore simple floral dresses or jeans. Most were farmers, scratching out a living growing corn, beans, and peanuts. Some of them made as little as a dollar a day. The faces of most of those in line were old and weathered, but there were children, too. Both young and old were filled with hope that they would be able to see again.

  The Maya people are very small. Some of the older patients were unable to see or walk and were carried by their children. Most of these patients were blind from cataracts. Cataracts are the most common ailment of the eye—the World Health Organization estimates that some 18 million people around the globe are blind from cataracts. In poor countries, cataracts can mean the difference between surviving and not surviving. The condition is mostly age-related or sun-related, or both. A cataract occurs when the lens of the eye becomes opaque or clouded. Functionally, the eye is still capable of seeing, but the opaque lens prevents light from passing through the eye to the retina in the back. Anyone who lives in Guatemala has accumulated a lot of sun over time. Probably half of the folks who came to the clinic couldn’t see the big E on the eye chart, or a hand moving in front of their faces, or even light. Essentially, many of them were blind.

  Cataract surgery begins by creating a small incision in the outer layer of the eye and then carefully making your way through the dilated pupil to the area just behind the iris. Access to the cloudy lens, or cataract, is achieved by tearing a circular opening in the extremely thin capsule. The cataract is then dissolved or removed in one piece. Finally, a plastic lens is placed inside the capsule and the wound is closed, often with no stitches.

  In two and a half d
ays in Salamá, I performed twenty-two surgeries, and our team performed more than two hundred. There were many emotional and tearful smiles as patches came off and patients discovered their newly regained sight.

  One patient was unforgettable. A truck driver named Hermenaldo had been blind for more than three years because of cataracts. During that sightless time, he’d lost his job, fifty pounds, and his family. When his patch came off, with tears running down his face, he showed us a photograph of his wife and told us in Spanish how she’d left him when he could no longer work and how he hoped to win her back. He got on his knees and thanked God for the miracle that had restored his vision.

  On our second day in surgery, a man showed up without an appointment and said that I had operated on his wife the day before, and that she was now able to see clearly for the first time in years. He wanted to know if I would help him also. I examined him and found that his cataracts were significant. We operated on him the next morning, and his wife was there to help unveil the patch. It was a powerful, emotional moment for me to see them looking at each other clearly for the first time in years. I remember hoping that their lives would be easier now. In remote Guatemala, if you are unable to see, there is little chance of work and not always food to eat.

  The wonderful thing about cataract surgery is that the results can be dramatic—not only can vision be restored to the blind, the results are often nearly immediate. For those whose surgery is successful, the moment the bandages are taken off is one of pure joy. It’s a truly awesome, unforgettable moment to witness.

  In the developing world, there are not enough surgeons to keep up with the demand. In Guatemala, and other countries closer to the equator, cataracts are not only more common but more severe. Most of the cataracts we removed in the clinic were mature, with the appearance of a small pebble, densely brown, black, and white. While we were able to help hundreds, the ultimate answer is more surgeons. The John Moran Eye Institute understands this plight and has scheduled time to bring the local eye surgeons to Utah for more training.