#381 - Dr. Sidney Zven’s Research on Addressing Food Insecurity in Military Families

Hello friends 👋

In this episode, Dr. Sidney Zven shares his unique journey from a civil engineering career to becoming a neonatology fellow at Walter Reed Military Medical Center. He discusses his experiences with food insecurity among military families, particularly focusing on WIC enrollment challenges and the impact of stigma and misinformation. Dr. Zven highlights his mentorship experience while working on a grant to address these issues and the importance of engaging stakeholders in community health initiatives. He also provides insights into his neonatology fellowship training and his aspirations for the future in military medicine.

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Short Bio: Dr. Sidney Zven grew up in New Jersey and attended college at the University of Michigan where he studied Civil Engineering. He spent the majority of his 6 year engineering career in Colorado where he worked first as a Civil Engineer, then progressing to superintendent and project manager. He met his wife in Colorado, and after moving for her work, decided to pursue a career in medicine. He was commissioned as an officer in the United States Air Force and attended the Uniformed Services University of the Health Sciences (Bethesda, MD). Upon graduation he completed Pediatric Residency at Walter Reed National Military Medicine, where he is also completing his 2 nd year of NICU fellowship

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The transcript of today's episode can be found below 👇

Srirupa (00:01.55)

Hello everyone, welcome to another episode of Rupa's Fellows Friday. Today we have with us Dr. Sidney Zven from Walter Reed National Military Medical Center. Dr. Zven has had an interesting pathway to medicine and to neonatology. He's currently a neonatology fellow at Walter Reed National Military Medical Center where he also completed his pediatric residency. I'm very excited to highlight the many accomplishments that you've done, Sidney, and I'm very excited that you could make time to come on the show with us. Welcome, and tell me a little bit about your training first, because that's the first thing I want to hear.

Sidney Zven (00:36.485)

Yeah, of course. Thank you for having me. I really appreciate it. So, you know, working all the way through, I'll start kind of at the scratch here. I grew up in New Jersey. I went to undergrad at the University of Michigan and did a degree in civil engineering there. And medicine was, to be honest, the furthest thing from my mind at the time. You know, I enjoyed myself in college, went off and went and got an engineering job. I worked out in Colorado for the better part of six years working on these big construction projects where I worked as an engineer and then worked as kind of a superintendent running the crews. And then ultimately wound up a project manager where I was running construction sites in Colorado Springs and in Denver. And during that time out in Colorado, I met my wife who was in the Air Force. She was finishing up at the Air Force Academy and we started to move around a little bit after that. And it was during that time that I realized maybe engineering wasn't everything I had wanted it to be. It wasn't as fulfilling as I had thought. And I'd kind of worked to a spot where I just really wasn't enjoying myself as much. And I really sought something that was fulfilling. And so that was one of the benefits of the military moving us around was it gave me a clean cut to really switch careers and say, I want to do something else. And so with my wife's encouragement, I pursued medicine. I went into medicine. I was fortunate enough to be accepted and start med school at the Uniformed Services University, which is the military medical school at Walter Reed in Bethesda, Maryland. I went through, did that. I was fortunate during med school. My wife and I had three kids during medical school. And so we were able to do that thanks to the military, no debt, making a good income there. And then I trained in pediatrics at Walter Reed and then I'm now a fellow at Walter Reed. I really kind of enjoyed my time there. I've been lucky to kind of stay in one spot for the majority of it here and had a pretty fun time here in the military.

Srirupa (02:20.152)

So to the listeners, when I said his pathway was interesting, this is why I wanted to start with that because that is such a fantastic pathway. I mean, wow, that was really, thank you so much for sharing that. So if I may ask you, what got you interested in neonatology?

Sidney Zven (02:36.007)

Yeah, that's a great question. Thanks. So I had no thoughts about pediatrics or neonatology. When I was leaving engineering, I thought I was going to go be a surgeon or something like that. And I actually spent the better part of a year in Boston with one of my big mentors. His name was Dr. Matthew Preventer. He had just gotten out of the Navy. He was the chief of sports medicine and orthopedic surgery at Mass General in Boston. And so he was the team doctor for the Patriots. He was this like amazing role model for me who taught me to work hard, emphasize the importance of research and evidence-based medicine, and really like really, really, really emphasized what it was to work hard and talked very highly and fondly of the military and his path in the military medical community as well. When I started med school, we were three weeks in and my wife gave birth to my oldest at 28 weeks. And so that was a huge shock for us. And we spent 10 weeks in the NICU with him. Over the course of medical school, we had two more kids. And as I kind of progressed on, I realized that the life and path of a surgeon wasn't exactly what I wanted anymore. It wasn't as family friendly. And ultimately, one of the things that I really learned during my like clerkship blocks in medical school was that I really enjoyed being around kids. I really enjoyed being around families, parents, sharing kind of my experiences with them, but also learning from them as well. And so I used to joke that if there was one thing that I could get from this and the military, you know, helping train me, it was to help me be a better parent as well. And so I was fortunate enough to learn from all the parents whose kids I took care of and all the parents that I came into contact with and was able to give them a little bit more help as well. And so ultimately, when I made the decision to pursue neonatology, the things I loved about it were one, the family aspect of things. You get to spend long times with these families at their most vulnerable moments. I got to share my experiences with them as a NICU parent at Walter Reed. I got to really bond with these families. And on the medical side of things, I really love the procedural aspect of things. There's not a lot of other worlds where you can be woken up from a dead sleep in the middle of the night and have 30 seconds to run to a delivery and have to resuscitate a 400 gram baby. That doesn't exist almost anywhere else. And so it was this combination of the high acuity, really fast-paced environment mixed with a little bit of the longitudinal long-term care. And it was that overall mixture of things that really attracted me to neonatology and what I really love about it.

Srirupa (05:04.802)

Yeah, no, I can relate and I echo what you just said that our parents are the biggest teachers that we have. Like there's so many perspectives of parents that are very valuable in us improving our care, are very valuable for us to improve the way we look at our babies and the way we are as neonatologists. And I think that's fantastic that you're bringing that perspective literally every day into their lives. So kudos to your amazing inputs on that as well.

Sidney Zven (05:32.179)

Thanks.

Srirupa (05:32.206)

So I see that you've done some fantastic work during fellowship and one of the things that I think that we would like to highlight today is your project on increasing WIC (Special Supplemental Nutrition Program for Women, Infants, and Children) enrollment in military families at Fort Campbell. Could you share a little bit about your experience doing this project and a little bit more detail on the project as well?

Sidney Zven (05:52.519)

Yeah, of course. I'll start kind of a little bit earlier ahead and kind of what got me interested in this work and really how I got started. And so a little bit of background on like military, the military and like food insecurity. You know, food insecurity impacts the entire population, the entire civilian population. And as I was kind of going through residency, it was the COVID pandemic and really kind of the tail end of it where we were starting to see a lot more of the impact of food insecurity. And so during my time in residency, I was, I remember this vividly. One of our co-residents had come back because the way the military works is that sometimes people will do their intern year and then they will go operate as a kind of general physician out in the Navy or the Air Force or the Army. And then they come back to finish the last two years of residency a couple of years later. And so one of my peers had come back and she was talking about WIC enrollment overseas, how it's a little different. And I remember thinking like, wow, this is so amazing. Why have we never talked about this at Walter Reed? Why have I not learned about this? Why have I not really learned about food insecurity? And I remember coming home one day and I talked to my wife who is active in the military still. And I said, hey, like I enrolled someone for WIC today. Look at me. And this was as a second year resident. And she looked at me, kind of disgusted. She was like, how, how have you just learned about this? And I was like, what do you mean? And I remember her telling me like, I like when she was enlisted, she was like, my friends were on WIC. And when now that she's an officer, she's like, the people I take care of, the people I manage, like I work to get them enrolled on WIC. I make sure that they have these resources. Like, why do you as a pediatrician not know about this and not know what you're doing? And so I was a little embarrassed. I was a lot of, a lot of embarrassed. And I really kind of took that to heart though, because this was something where I was like, you're absolutely right. Like, why don't we know about this? Why don't we utilize this? Why don't we use this resource to help our families? And so what I did during residency was I was very, very fortunate. I was able to kind of work with some really good mentors and I put together this like WIC calculator to determine whether or not military members were eligible. And so I was utilizing it myself, other residents, other attendings were kind of utilizing it. And then as we progressed on, we onboarded over at USUHS (Uniformed Services University of the Health Sciences), one of my biggest mentors right now, Dr. Bini Chakraborti. She came from Children's National and she came over and one of her biggest research interests was in overall healthcare disparities. And so one of my mentors, Dr. Joseph LoPreiato, he's one of the most senior Navy pediatricians we have, he was like, hey, you two should get together, you should talk about this. We met at PAS (Pediatric Academic Societies), we talked, she helped me stand up my project at Walter Reed. And what we did there was we screened the entire Walter Reed pediatric and obstetric clinics for a month period. And we realized, no, this is a real problem. Like people aren't utilizing WIC, people aren't aware of it. And 70% of our WIC eligible families didn't even know about WIC and weren't enrolled. And so as this was all happening, the DoD (Department of Defense) released a big report where in 2022, they found kind of as we were coming out of the COVID pandemic, they realized that 24% of military members were food insecure. And so like one in four military members didn't have the means to get enough food. And that was impacting major aspects of our military from retention, from overall health, from dependent health. And overall, my focus was on how does this impact our kids? And so as I went into fellowship and started entering that way, Dr. Chakraborti and I put together the idea to apply for a grant to go ahead and try and really impact a community and utilize like a novel way to do this. And so during residency, we go to Fort Campbell, which is out in Kentucky, and we do kind of a pretending month for newborn nursery. During that month, I was able to make the connections and we put together this program using our military database to really identify who is likely WIC eligible there, and then we tried to recruit them. And so we sent mailers out, we made phone calls, we hired a community health worker who was able to kind of screen all of these families, and we were able to really engage with over a thousand people there at Fort Campbell to help figure out if they were WIC eligible and if they were WIC eligible to refer them to the local WIC offices and help them get enrolled. And so doing that helped a lot of families there. It helped the WIC offices be a little bit more aware of the unique military problem we had. And overall, my hope was that it would help food insecurity rates down there. And I think it has. And so now as we kind of head into the next steps of things, we're working a little bit more broadly with the DoD and some of our bigger partners to figure out how we can do this longitudinally across the military, not just in Kentucky, not just at Walter Reed, but for everyone in a way that destigmatizes food insecurity and gets people the help that they need.

Srirupa (10:28.546)

No, that's so impactful and amazing. And so what were the factors that were sort of contributing to people not knowing about WIC? Like, is that just ignorance that they just didn't know this existed? And as part of your project, part of that was like educating people that, you know, there's this amazing resource. Share that with us. Like, what were the factors that were associated with it?

Sidney Zven (10:50.611)

Yeah, it's funny you ask because that was actually one of the things that we did after our initial projects was we did some focus groups and we asked people across the country through surveys and focus groups who said, what caused this? And ultimately the biggest factors were stigma. People don't want to ask for help. I mean, people in the military are proud and they don't want to have to go ask for help and say, I don't know what I'm doing. I don't have enough money for X, Y, and Z. It's kind of societal right now where people are afraid to ask for help. You know, with social media and everything else, you see everybody else smiling, happy. Everything is great. Everything is good. But really behind kind of that veil of social media, you realize like people are struggling. And that's what we really hope to do to empower people to say, I need help or for us to say, hey, you may or may not need it, but here are resources just in case you do. And so stigma was the biggest one. They didn't want to ask for help. The second major one was there was a lot of misinformation about it. So SNAP (Supplemental Nutrition Assistance Program) is another kind of food insecurity resource that's federally funded whereas WIC is more state based. And so there's different qualification criteria. And the way it's set up for military members is that for WIC eligibility, your housing allowance doesn't count towards your income for WIC eligibility, whereas it does for SNAP. And so a lot of families thought, well, I'm not eligible for SNAP, so why even waste my time applying for WIC? And other people said, yeah, you're not eligible, don't bother. And that's where we really work to try and overcome that and try and overcome that misinformation through the creation of pamphlets and other materials so that we could help educate these families that, no, no, you are eligible. And your children can receive benefits. And so those were the major aspects of things. There's the difficulty of having to go to all your doctor's appointments at the military base and then having to go to the WIC offices and repeat all of these heights, weights, measurements, labs, things like that. There was lots of aspects like that where the COVID pandemic was actually really helpful. They allowed people to start doing some of those WIC appointments virtually, and that was what we hope to encourage these local WIC offices to continue on with. To help streamline the process. And down in Kentucky and Tennessee, the two states that we were heavily involved in in this project, they started being able to do that. And so those were the main things, stigma, misinformation, and then overall accessibility and the ease of doing it. And those are things that we're still kind of working on and trying to figure out the best way to overcome that.

Srirupa (13:01.752)

Yeah, no, that sounds like another side project that you've kind of explored, which is fantastic. And for the listeners, Sidney, you've accomplished so much. I think the amount of publications and awards that you've gotten, that's been so great. And I'm so happy and proud that you're advocating for your patients there. Tell me a little bit about, you mentioned a grant that you're working on for this project. So tell me your experience in working on that grant. Maybe part of it, tell me a little bit about your mentorship and how you found your mentor.

Sidney Zven (13:34.375)

Yeah, of course. So I'll be honest with you here, the grant writing, a large component of it, I was so, so, so fortunate to have Dr. Chakraborti involved. I mean, she took really the burden of this. I was, we were applying and submitting, like as I was applying to fellowship, and she was like, you have a job to be the best neonatologist you can be and to train and learn. She's like, part of this is my job. So like, you're going to be involved, you're going to help, but like she took the burden of it. So I want to give her all the credit in the world because without her, this wouldn't have been possible at all. But kind of going through it, she was so helpful and instrumental in kind of helping parse out the little pieces, little bite-sized pieces that I could help with at a time so that it wasn't like, hey, here's the whole grant, ready, go. It was like, hey, let's work on this aspect of things. Let's put together this introduction. Let's do this. Let's do the other. We put it all together. We kind of helped get other people involved, really troubleshoot it a lot. The major aspects of it that I never realized how important they would be when we were applying for the grant and writing that grant were overall the networking that we had to do. I mean, the biggest aspect of it wasn't so much the writing of the grant, which I had had some experience in medical and research writing. So that part wasn't as hard and she took a big component of that too. But really it was setting up a lot of cold call meetings with a lot of local WIC offices, a lot of national WIC offices, a lot of military advocacy networks, earning their trust, pitching them on the idea and really telling them like, this is what we hope to do and we hope to get the funding through this grant. And if we don't, I'm sorry, like we may not be able to do much. And so that was really it. In a little bit, I had to become a salesman where I was kind of going through and giving everybody the elevator pitch and then getting to the next level and talking to the next higher levels up and asking for letters of support. And that's really, that was really an eye-opening aspect of things because I didn't realize how many people are involved in a grant process. You think it's easy. You just, you write this, someone will read it. They'll understand how important this work is and they'll give you money. It's not that easy. And it really is important to get everybody on your side, both on your grant team and on your project team, but also the ancillary people too, who'll be able to support and really help as you progress through that grant. And that was really difficult and that was really hard. And again, I was so fortunate for Dr. Chakraborti and her mentorship. I had kind of mentioned it before, but she came over to USUHS right at the time that I was in the middle of residency and we were fortunate that Dr. LoPreiato, who was always my biggest mentor and always looking out for me, he was like, you two need to connect. And so she saw how passionate I was about it. She saw how dedicated I was to it and she was just as dedicated. And so she's been instrumental. We've known each other now for going on four years where she's continued to motivate me, continued to help in any capacity I can. There was periods there where we were talking multiple times a day for what felt like years at a time. And I remember when I was studying for boards, she was like, we're not gonna talk every day. We're gonna take a step back here and I'm gonna let you focus on this. And we've had a really close relationship. We know each other very, very well now. And really it was fate more than anything, but she's been phenomenal and I'm so happy to have her on my side.

Srirupa (16:39.97)

That is such a fantastic mentee mentor relationship. I think that a mentee mentor relationship is so interesting that, you know, there's not going to be a week that you don't like text each other. I would say like, I feel like that's how the relationship roles, but also I'm so glad that you both connected on something that you're equally probably, you know, very, very passionate about. So that's wonderful. You mentioned a little bit about your meetings with ancillary staff, and I'm curious to know how was everyone's, all of the ancillary staff's reaction to this project? I think that any project, any research project that has such a significant impact on the community has to have so many of these stakeholders convinced and accepted and on board. How was your experience in convincing them and what was their reaction to this project?

Sidney Zven (17:28.967)

Yeah, we were very fortunate. I think for the most part, everybody realized that this was a position and a problem for people. And not so much a problem in the sense of like, it is, I mean, it obviously is not great, but they knew it was a situation where you could make a lot of impact. It just really required someone to go ahead and do it. And so we reached out to groups like the Kentucky WIC Council, the Tennessee WIC office as well. And we were able to really reach out to kind of high levels of those offices very, very quickly and easily. And I think the main aspect of things that I tried to really impart to them was that we would be taking on the brunt of this work, and we would really want to use them as like a local liaison to kind of help smooth around the edges when we didn't really know who to go to or how to go to it. And all of them were like, this is phenomenal, anything you can do would be helpful. But I really reinforced with them that we were hiring community health workers, we'd be taking on the brunt of this ourselves. And the majority of the work that we would need from them would be more in support of our project and helping us kind of answer questions and really figure out the logistics of things. Now, that was a little bit short-sighted because when we did roll our project out and get going, what happened was we had gone to the higher levels of these offices, national WIC organizations, national military advocacy groups, the heads of the hospital and the heads of the base, but at the lower local level, we ran into some issues where all of a sudden these local Kentucky and Tennessee WIC offices, because Fort Campbell is right on the border between the two, all of a sudden they went from a couple people coming into the office every day to they had a hundred people coming into the office one day and they're like, what the heck is going on? And so that's when we realized, oh no, we should have given them a heads up ahead of time. And so a little bit of food, a little bit of conversation and a couple education sessions helped them understand and get on board as well. But they were like, what the heck is going on right now? And they were shocked. And that's a huge work burden on them as well. And so that was one experience that we had where we were like, if we could have done it differently, we would have gone to them ahead of time and we would have let them know and we would have staggered this and prepared. But we were so excited and so happy and ready to try and help people that we were a bit overzealous. And if I had to do it again, that's what I would have done. But we were really fortunate because when we reached out to a lot of these organizations, they all said, yes, this is great, go ahead. You don't need much from us right now? Okay, sounds good. Let us know what you need and we'll work with you then. So again, I was fortunate with Dr. Chakraborti. We had a great plan. It was all kind of trouble shot ahead of time for the most part. And so people were ready to support us.

Srirupa (20:00.236)

That's awesome. Tell me, you kind of mentioned that you did focus groups on understanding factors that were hindering the utility of WIC. Did you all try to have focus groups after your project came into being? Like, what was the reaction of the people? Like, how did they take it?

Sidney Zven (20:18.417)

Yeah, so we haven't finished up the project here at Fort Campbell yet. And so we haven't had the focus groups yet. That's our next step here is to really gauge their experience and how effective this was or how ineffective it was. We have a community health worker who works full time at Fort Campbell. So she's kind of the boots on the ground there. And speaking with her, she's had a lot of positive things, a lot of positive insights as things happen. You know, she's got a cell phone she gets reached out to by all of these families directly. And so over the year, two years, as we've been running the project, when problems pop up like, hey, this WIC office is like, what the heck? What are you doing here? We don't want you here. Come back tomorrow. I can't come back tomorrow. As problems like that are kind of arising, we're getting kind of real time results from that. And so our hope here is that in the coming year, during my third year here, we'll be able to set up some of those focus groups and get a little bit of a better idea of one, not only how effective was our initial messaging by sending mailers out versus calling families, but also how hard was it to go to the WIC offices? What were some struggles? What were some things that worked? And then now as families have to re-up with WIC after a year, are there challenges with that? Are there not? As families move to different states because in the military you move, are they experiencing issues with that or are they able to seamlessly do it because of some of the resources we've provided them? So that's the hope here in the coming year and we'll go from there and see.

Srirupa (21:36.386)

So I think you answered part of my question, but if there are additional points to add here, how do you foresee this project taking shape in the next few years, especially in your third year?

Sidney Zven (21:47.857)

Yeah. So really, it's the final, the last step here for us before we kind of broaden out into different projects is really figuring out how effective it was. So we have our numbers about who we contacted, who we determined were WIC eligible, who we were able to get over to the WIC offices. And so, and we're right now finalizing who actually was able to go get enrolled. A secondary aspect of this was who's able to stay enrolled at six months. Is there a problem with maintaining family's enrollment? Because that was something we had heard a couple years ago was, yeah, I can get enrolled, but then they're asking me for all this extra paperwork, all these extra appointments. And so we had hoped that through some of the extra legwork we did with these local WIC offices, that the virtual aspect of things were kind of decreasing some of the administrative burden for families would work. And so that's the last step here of the project itself is how many people were we able to keep enrolled here over that six month period? Going into some of the focus groups about what can we do better and what worked really well. And then big picture as we had talked about before, is this something that we can expand military wide across the continental United States so that we can easily utilize like our informatics based approach to pull up a list of these families and send out mailers or send out phone calls or text messages and say, hey, you might be eligible, click this link, screen yourself. And if you need to go somewhere, if you are eligible, here's the link to do it. Here's your local WIC office. Walk on in with this paperwork and off you go. That's our hope, big picture. It's gonna take a little bit of time though.

Srirupa (23:16.862)

That's just amazing. And tell me a little bit about, and this is a little bit of a detour from our discussion, but I would love to understand your neonatology fellowship training itself, because it seems like some of your families do go to other sites. So as part of your training, do you also go to these sites? Or could you kind of describe your training in general at Walter Reed?

Sidney Zven (23:38.931)

Yeah, of course. You know, so I'll start with medical school here and I'll kind of work my way up because a lot of people might not be familiar with the Uniformed Services University. The military medical school, it's free. You're an active duty officer during it. You're getting paid as an officer. You leave with no debt. And it's it was what some of the best medical school training I could have. Half our class was split up into non-traditional students that are like 30 and above, either with civilian careers or military careers. And then the other half is kind of more traditional candidates. And you go through your schooling and you go through your clerkships at all the military hospitals across the United States. So I had a friend who got sent to Hawaii, San Diego, Texas, all these fun places where he was having a good time. And it felt like vacationing. Now I had kids at the time, so I did my best to stay local here so that I could help be a part of raising them. So some of my classmates, they were out having adventures and I was so envious of them. They were living the life. Residency for...

Srirupa (24:35.118)

You were having your adventure of your own with your kids, I suppose.

Sidney Zven (24:37.651)

I was, I was, but boy was it challenging. But I would do it again if I had to. But so residency was great. During residency, the majority of your rotations are here at Walter Reed, but we're fortunate in DC that we are next to Children's National and also Inova, both of which have residency programs. And so during residency, I did some outside rotations in ICU type settings. So I did a NICU rotation, a couple NICU rotations at Inova Fairfax. We went to Children's National for PICU. You work on their metabolic team. You work in their pediatric emergency room. You work in the pediatric emergency room at Inova. And so you really get an exposure into these high level, high acuity civilian environments, and then come back into the military system where the acuity isn't as high and the volume is not as high, but your resources are not as high as well. And so you're asked to take on a little bit larger burden. And so as I went into fellowship, at Walter Reed, we're a level three NICU. Typically, our census is anywhere between eight and 14 babies. We're getting ready to move into a new NICU unit here that just got finished construction that'll let us get all the way up to, I believe, it's 28 babies, which doesn't sound like a lot for these 110 bed NICUs, but it's us. It's an attending, it's a fellow, and it's a resident. And you take on a huge aspect of the administrative burden. You're doing a lot of the case management, the social work, the DME (durable medical equipment), all those aspects of things too. It really is kind of an all-intensive thing and it prepares us for our military careers. And so in our fellowship right now, we spend time at Children's National and their level four NICU. We spend a good bit of time at the Inova Fairfax NICU, which is a high volume 110 bed level four center as well. We spend time at Georgetown, which is another level four with a big transport team where you get to fly around on the helicopters. And then we also spend time at Shady Grove and a little bit of time at the University of Maryland. And so we really get exposure to a lot of these different hospitals and really get to see the different ways things are done. And to be fair, it's amazing. Like, I love it. Like, I've, there are some attendings at Children's that I've spoken to and, you know, they're like, hey, I was local for med school. I went to Children's for residency. I was a chief here. I was an attending here. This is all I know. Our protocols, our procedures, you know, the oscillator, we don't use the jet here. And they're good at what they do, but we're fortunate, Walter Reed, to touch on all the different hospitals in the local area, to be able to train with all of them. And honestly, to have some top cover where we say, hey, I've been to all these places, I've noticed all these things are done differently. Can you explain to me why you do it this way? And it's really great for our education and our learning. There are the downsides. You have to go to a new hospital, you have to learn everything again, a new EMR (electronic medical record), new people, new nurses, new RTs (respiratory therapists), new attendings. But the hope here and kind of the path that we're going down right now is we're doing a little bit more and we're narrowing down our focus on the hospitals that we're working with. And so that will hopefully be a little bit more streamlined and will kind of get us a little bit more of a partnership and maybe two, three different hospitals that we work at instead of the six that I've been able to go to through fellowship. So I've loved it. It's amazing. Change of pace in all these different places, large delivery centers, large transfer centers, transport, ECMO (extracorporeal membrane oxygenation), everything in between. And then we get to come back to Walter Reed where we're treated as kind of peers with our attendings and we really get to practice developing our practice. We get a lot of leeway and we really get to practice medicine there. And it's fun, it's awesome. We build autonomy and we've got a great group of attendings at Walter Reed that love to learn from us. The nurses love to hear about us because a lot of them have come from these surrounding centers. So they love to hear how things are going on there. But yeah, that's the unique aspect of our training is we really get to go to a bunch of different places and learn different things and figure out how we want to practice medicine.

Srirupa (28:23.468)

That's fantastic and thank you so much for sharing and I agree a lot of us are not aware about all of this and so this is fantastic that you were able to share with us your journey and in general the journey at Walter Reed. So going to my final question, you've done all of these fantastic advocacy projects and research projects during your training. Where do you see yourself going in the next few years in terms of like how do you want to take this forward and how is your career going to look like or how do you foresee your career to look like I suppose.

Sidney Zven (28:56.827)

Yeah, that's a little bit of a hard question. So in the military, you have certain choices of where you can go. And part of it is based on your family and extenuating circumstances. Part of it's on your preference and part of it's on the overall need of the military. So in my case, the Air Force. And so for the Air Force, there's five places we can go. Japan is one of those places in Okinawa. It's a little bit of a smaller NICU that doesn't have as high of a volume, but they're also responsible for the transport mission. So over on that part of the world, there's a lot of different local little pediatrics offices internationally. And if there's a baby, a NICU baby that pops out, they're the ones that go get them. They go transport them to Okinawa or back to the United States. And so they have a really cool mission there where they get to fly around all over the place and really take care of these babies all over the place. Another one of the locations is out in Hawaii at Tripler Medical Center there. Another kind of resource, not resource limited, but it's a little bit of a smaller area taking care of a really unique population with one other major civilian center on base at Kapiolani. We can go to San Antonio as well, which is a large Air Force and Army base. I can be at Walter Reed, which is where I'm at right now. That's a great spot for me. Obviously, I've got a lot of relationships and really have enjoyed my time here and have been able to do a lot as far as overall military advocacy and research and furthering my time in the military. We get the NIH (National Institutes of Health) across the street who we partner with. We've got USUHS and we've got a lot of other local research organizations with the Defense Health Agency, excuse me, and then over at the Pentagon and our large scale like DoD leadership. And then the last location that I can go to is down at Portsmouth, which is down in Southern Virginia, and that's a big naval base, lots of babies popping out there, and that's a fun place too. And so all of the bases have their unique little differences to them. They all have kind of different support staff, different missions, different kind of components, but the one beautiful thing in the military is that you're just a phone call away. And so regardless of where I'm asked to go, I can continue to do my research and I can continue to kind of do it because that's the beauty of technology these days. And so the relationships that I've built through USUHS, through Walter Reed, and through kind of our local national capital region here. If I'm able to stay phenomenal, if not, I hope to continue on with this research at any of the other local bases that I'm at there. My hope and my passion really is making sure that we take the best care of military families that we can. I want us to be able to offer the best sides of civilian care and the best sides of military care. You know, high level care, high level medical care, but also a little bit more of like the actual, the qualitative side of care where we have lower volumes, we're able to offer a little bit more, we're able to offer a little bit more individualized care, we're able to establish a little bit more time with our families, spend more time with them. And so my hope is to be able to do that, both from a medical side, but also from a research side. How do we improve our overall outcomes? And how do we overall improve our quality of life for our military members so that it impacts their children and them in a positive way? And so my hope is to continue on with this research like I talked about before, to continue on with additional research and really to be the best neonatologist I can be so that I can keep doing what I'm doing now here. I'm following in the footsteps of a lot of my clinical mentors here, spending time at some of the civilian hospitals as an attending wherever that may be and really keeping my skills sharp as well. So in summary, I wanna keep working hard. I wanna try to keep being a good dad, a good husband, but really I wanna be a great neonatologist and I wanna keep researching to help kind of push along military medicine.

Srirupa (32:35.084)

No, that's fantastic. And with how you've done so far, I think there, I don't have any doubt that that would be definitely something in your cards in the future. So you, you've done amazing already, Sidney. And I'm so grateful that you were able to join in and share your journey with us. Thank you so much for your time today and good luck.

Sidney Zven (32:53.597)

Thank you so much, I really appreciate it, thank you.