Meet Dr. DiFazio
Marc DiFazio, MD, is the Medical Director of the Montgomery County Outpatient Center at Children’s National, as well as the Medical Director of Ambulatory Neurology. He completed his Pediatric and Neurology training at Walter Reed Army Medical Center, and went on to become the Chief of Child Neurology at Walter Reed, where he served on Active Duty until 2005 before transitioning to private practice in Rockville, MD.
His leadership activities at Children’s National recently include his service as the incumbent Medical Executive Staff President. He continues to serve in the Army Reserves as Command Surgeon of Legal Command, USARC. He is well-known to the community for his service, leadership, and expertise in clinical child neurology, with particular emphasis in the areas of Tourette syndrome, headache/migraine, concussion, and the use of botulinum toxin (Botox) for a variety of conditions including headache, spasticity, and sialorrhea. Dr. DiFazio also has experience in medical care and student/resident education in the Developing world. He participated in the Inaugural and subsequent “Pediatrics on the Nile” educational seminars for clinicians in Ethiopia. While there, he taught residents, students, and Attendings at the bedside and in formal lectures at Black Lion Hospital in Addis Ababa. He has also traveled to the United Arab Emirates and Kuwait to educate caregivers there as they work to develop their in-country medical systems.
Dr. DiFazio’s interest in global health has long been a part of his professional goals. However, despite being in the Army for over 30 years and on active duty for over 20, he never got the opportunity to deploy overseas. Still thinking about his long time goal to work in low and middle income countries, and just as his children were growing older, Dr. DiFazio had the opportunity to go and teach in Ethiopia. Wanting to give back but “not really to go and put a band-aid on someone,” he said the opportunity was a chance to “really make a difference and impart knowledge.”
So in 2011, Dr. DiFazio travelled to Ethiopia, recruited by an expat pediatrician working at a local hospital in Addis Ababa. Together, they provided educational sessions for local physicians and providers “in the form of a novel 48 hour pediatric and specialty training.” The sessions went well, and “luckily” describes Dr. DiFazio, the majority of providers able to attend, did. Constantly asking to be shown new skills and how to use equipment resources only recently available to them, Dr. DiFazio remembers these providers as “absolutely thirsty for knowledge and so appreciative.” Their desire to learn and their passion for advancing the care they can provide inspired Dr. DiFazio, and left him with the feeling that it is important to “keep up this enthusiasm” in his own professional practice. “The western world can really learn from these providers,” he adds.
Travelling back to Addis Ababa the following year for another educational session, focusing on training mostly for residents and faculty providers, Dr. DiFazio and his colleague were struck by the level of sickness they would see amongst children there. “Conditions are allowed to progress further than anything you would see here now,” says Dr. DiFazio, and seeing these kids is “impactful for any western provider.”
While it was frustrating to see these conditions still affecting children’s lives, Dr. DiFazio reports being impressed by the level at which local providers were able to care for and manage these cases, preventing mortality in some very advanced illnesses. Still, he says, “the amount of kids who came in with a totally preventable condition…was so shocking.” He couldn’t help thinking, “this kid did not have to go through this.” However, increased educational and training resources has helped mitigate some of these communities’ need for providers, effectively expanding their pediatric care capacity in a sustainable way.
Inspired to pursue similar training missions, Dr. DiFazio has travelled to the United Arab Emirates and Kuwait. In the UAE, Dr. DiFazio taught residents how to conduct physical therapy for children with cerebral palsy. The experience was “really most impactful for patients in terms of the care they would now have access to.” Advancing care and making this kind of treatment available not only improves quality of life for these children, it also reduces the amount of resources necessary for their daily care down the line. While it can be nice to feel like the “expert from the US,” Dr. DiFazio remarks that the true impact lies in expanding access to and quality of care for as many kids as possible.
Dr. DiFazio also relishes the opportunity to represent both the US and Children’s National in a global setting. In Kuwait, in addition to providing care for patients and education for providers, he and colleagues held lectures and discussions for different parent groups. “I love the opportunity to be an emissary from the US who is smiling, smart, and kind..here helping out…and also to be a representative from Children’s, being there, (making a difference) on a global stage.”
In addition to educational outreach, Dr. DiFazio is increasingly interested in expanding access to life-changing resources, namely the use of therapeutic hypothermia to decrease the neurological impacts of hypoxia or ischemia on neonates during childbirth. While “you can take care of a baby who has been hurt during the delivery process after the fact,” he says, the question to answer now is, “how can we prevent this from happening again?” A colleague who worked with Dr. DiFazio in Ethiopia, an OB/GYN, reported seeing “a ton of hypoxic ischemic injury, which” adds Dr. DiFazio, “in the US would either not happen or the kid would be treated very differently.” While the treatment process is relatively simple in the US, in the hot climes of Ethiopia, where air conditioning is sparse if available at all, figuring out how to keep babies cool is no easy task.
Dr. DiFazio and his colleagues managed to create a cooling system and wrote a protocol for its use, however they encountered a new obstacle: parents didn’t want their baby to be cooled. “In Ethiopia, you’ll notice that all babies have their head covered and it is culturally important and significant to keep them warm,” says Dr. DiFazio. Luckily, another provider working with the team was able to create an educational video for parents. “It was also educational for the residents,” adds Dr. DiFazio, as providers were very well read on the beneficial effects of such treatment, “but they were hesitant to be the first ones to do it.” These efforts are well worth it. “We can transfer kids (with cerebral palsy) from (being) able to walk to…fully ambulatory,” says Dr. DiFazio, adding, “we can really have a huge impact on the amount of resources necessary to maintain these kids.”
Currently, inspired by his previous successes, Dr. DiFazio is interested in expanding access to this life changing treatment to children around the world. He is also increasingly interested in educational outreach and training, and has facilitated a partnership between Children’s National and the Bahir Dar University in Ethiopia. While there, he met with the University President, the Dean of the Medical School, and the Academic Chair and once he returned to the US, Dr. DiFazio met with the GHI team and the new pediatric Dean here at Children’s. They are now anticipating getting the first group of CNHS residents to Bahir Dar by late winter or early spring. “I’ll likely go with them, get them settled, and then see about getting a group of Ethiopian residents over here,” he adds.
At the end of the day, for Dr. DiFazio, global health is about working against the “obvious disparities across various geographies,” to improve children’s lives everywhere. Really, he says, “our country has (some many resources), it should almost be mandated, and if we all (US providers) gave back it would totally change the ball game.” In addition, considering the “real hurt to our global image” American’s have suffered recently, Dr. DiFazio emphasizes the importance of working to restore the vision of Americans as beneficent, caring, and kind. “When I go abroad as a military member and as a civilian, I am absolutely a representative of the US and I go with a smile, and a gentle touch. I want the message to be, these are a kind, and helpful group of people. To get back to that image of America,” says Dr. DiFazio, “would be my number one goal.”