Critical Analysis of the Essay as an Effective Form of Comparing the Situation of Foreign-Language Dental Students from Polish University During the SARS-CoV-2 Pandemic

At the beginning of 2020, the world faced alarming information that coronavirus (SARS-CoV-2) infection was quickly spreading across the world. On March 11th, the World Health Organization (WHO) officially announced that the viral infection fulfilled the criteria to be classed as a worldwide pandemic. The number of patient with COVID-19 was rapidly increasing across all continents - except the Antarctic (by November 12, 2020, there are already 51 547 733 cases reported globally, 1 275 979 deaths) [1]. The situation induced implementing emergency protective measures by the governments of countries all over the world. In Poland first case of SARS-CoV-2 infection was confirmed on March 4th 2020. Sixteen days later epidemic status was announced [1]. Decisions were quickly made and the closure of most of the public institutions, temples and also borders was announced. Also most of the mass events were cancelled. As expected the controlled lockdown was not only a huge shock to communities across the globe but it was also an emotional struggle. There were predictions and expectations of economic disturbances and much uncertainty began to fill the public on what the days ahead of them would hold.

Moreover, it was an exceptional struggle for many students as there was an immediate disturbance to their studies due to the closure of educational institutions. It was likely that this was especially difficult and stressful for the international students of the final year as not only were their studies interrupted, but they were also trapped in a foreign country due to the closure of the Polish borders. Imperative for rapid adaptation to new on-line form of classes, waiting for decisions about the new construction of exams must have been especially difficult [1-3]. Although the actual global health problem is deadliest since the influenza experience of 1918- the situations of isolation are known in history. The examples may be epidemics of Severe Acute Respiratory Syndrome (SARS) and H1N1 flu that also resulted in temporary separation of local and foreign students and employees from their usual studying routine or occupational activities [2-5]. It is very important to look for a research tool, that will give a chance of as good as possible assessment of emotions. In the time of crisis a perfect tool, very often used by Polish sociologists is a personal journal (essay) [6].

Aim of the study

The aim of the study was the critical analysis of essays written by the final year dental students (both English Division and Polish students), studying at the Faculty of Medical Sciences in Zabrze, Medical University of Silesia. The main purpose was to identify and compare the main difficulties they had to cope with, and the analysis of potential benefits and losses felt by each individual due to the pandemic and lockdown.

Students of Vth Year Dentistry at the Faculty of Medical Sciences in Zabrze, Medical University of Silesia wrote essays, involving following issues:
A. Adaptation to e-learning.
B. Losses and benefits due to the pandemic.
C. Adaptation to isolation and lockdown.
D. Own reflections regarding life during pandemic.
Twelve students took part in the research, six from English Division and six Polish.
The English Division students was composed of six students, two female and to male, in the age of range: 24-28. Four of them came from United Kingdom, one from Iraq, one from Sweden and one from Saudi Arabia. Polish students that took part in the research were all women age 24-27.

The data of the authors of the received essay has been kept confidential and the analysis of the texts has been carried out by the researcher who did not carry out classes with the students who responded to the invitation to research. The obtained results were grouped into areas of the discussed issues and then subjected to comparative analysis.

Adaptation to e-learning

Students in both groups (100%) declared that the necessity to attend on-line courses was a challenge. They all agreed that this kind of education has both advantages and disadvantages. Table 1 presents advantages and disadvantages of e-learning due to the examined group. For polish students (25 %) the most stressful were technical issues related with the e-learning platform and with the quality of internet connection but also the loss of practical classes, what they took as a cause of lack of self-assurance in future clinical work:

Table 1:Advantages and disadvantages of e-learning due to the analyzed group.

1. “…When the e-learning started I was challenged with installation all of necessary applications and getting know them better…It was very difficult at the beginning as I am not a person who deals well with all those platforms and IT systems.”; Kinga, PL
2. “…Tests on the e-learning platform were a kind of a challenge. On one side they were a motivation for a regular learning, but on the other hand they had one disadvantage, technology is not unreliable …”: Monika, PL
3. “…It will be more stressful for me to take all the final exam in on-line system due to the possible technical problems that may occur …”, Monika C, PL
What is more, students (25%) from Poland declared that before the pandemic they made some effort to cut on internet in order to have more time for other activities. For them it was a disadvantage of the e-learning as that they were forced to spend more time in front of the computer “…most of my time I spent in the virtual reality what I tried not to do earlier …”, Paulina, PL.
Not wasting the time for the travelling to the University was the main advantage of the e-learning mentioned by the Polish students: A. “… Now instead of being in a hurry and scared of being late for the classes, wasting my time on travelling and fighting for the seat place in overcrowded classes I can sit in my training suit with the cap of hot tea …”; Paulina, PL
B. “…The biggest advantage is that I am not wasting my time on driving to the University, I can get up 15 minutes before the classes start and I am not late …; Kinga, PL
C. ” …It is a great advantage that I am not wasting my time on driving to the University what normally took me 40 minutes…”; Dominika, PL.
Polish students (50%) were worried about the lack of practical classes and its impact of their future skills:
A. “…the lack of the contact with the patient for almost half a year (from march till October) for sure can’t be omitted. Due to that I am much more scared of the beginning of my postgraduate internship …”; Monika D, PL
B. “…unfortunately, even the best lecture can’t take place of treating the real patient …”; Dominika, PL
C. “…definitely I’d rather go out of that comfort zone to treat patients and get the knowledge out of the practical classes …”; Paulina, PL
D. “…even the best lecture can’t take place of practical classes and learning on my own mistakes and improving my skills…”; Monika C, PL

Adaptation to lockdown

The information about the closure of Polish borders surprised both groups of students. It would seem that it would be more difficult to accept by the foreigners. However, most of them highlighted that since they took a decision about studying abroad they live in a kind of lockdown, so that decision taken by a polish government did not change their lives very much. They were much more scared that it will influence their future career as most of them planned to have their postgraduate internship in their countries (50%):
a. “…as soon as it was known that Poland was going into lockdown many international students that I know, rushed back to their home countries and told me to do the same but I was stubborn. What if it would prevent me from taking my diploma exams? I wasn’t willing to take the risk…”; Ryan, UK
b. “…but the main concern that really affected me mentally is the uncertainty of what is going to happen to you in regards to career your education that you have invested so much in. will it finish? How long are you stuck here?..”; Tina, UK
c. “…I now also face the issue of what my future is going to look like. I wish to return to England and start my career there...”; Kate, UK
d. “…The isolation itself isn’t too bad as I’ve lived in Poland for a long time..”, “…This is also affecting all of my UK internship possibilities -because obviously foreigners are not their main priority right now and with all the borders being closed… “; Martin, UK
e. “…The initial thing that transpired to me was that I had to leave Poland and being in a dilemma of choosing whether to stay or leave was nerve-wracking. All this time, my thoughts rotated on the possibility of schools reopening and me not being able to go back…”; Ali, Sweden.
The problem of borders’ closure affected one of the Polish students whose father worked abroad: “…my father works abroad and he can’t come back home. We didn’t realize that the lockdown would last so long. If my dad came back home we wouldn’t have enough money for living, unfortunately. The most difficult was the Easter time, of course we were keeping in touch with him…”; Kinga PL. The analysis of the students’ essays proved that both groups of the students had to face similar problems because of social distancing (100%). They missed meetings with their friends, lack of activity due to the closure of gyms:
a. “…Human contact. I’d forgotten what that was. After that moment I knew that I needed to go outside daily for my own sanity...”; Ryan, UK
b. “.Before the pandemic I had regular meetings with my friends, I was going to the gym and swimming-pool etc..”,’… I have been already missing my normal, busy life, meeting friends, doing shopping…”; Kinga, PL
c. “…I was very affected by the fact that I have to stay at home…”; Monika D, PL
d. “…Unable to enjoy and do daily outdoor activities and be more interactive and the freedom of meeting people became dramatically restricted and that one is very deeply taking its huge negative effect on me personally…”; Adi, Saudi Arabia
e. “…I lost my life that’s what I lost, everything I do I lost even going down the road to grab McDonalds … you know people start appreciate things only when they lose them because maybe we were ignored regarding that fact but it true…”; Mohammed, Iraq
f. Even though it was a difficult time for most of us, future dentists pointed that pandemic gave them a chance for the selfdevelopment, new hobbies, getting new skills, improvement of other. Polish students mentioned the possibility of strengthening ties with their families:
g. “…Benefits hmmm I never cooked in my life apart from doing fries, but now I know lots of recipes and start liking to cook…”; Mohammed, Iraq
h. “.. I hate running but I figured why not. It’s been 3 weeks and I have been running 5km everyday..”; “... I started to bake cookies and cakes, I was experimenting more with my cooking…”; Ryan, UK
i. “…I spend my free time on cooking (I finally made my own bread), we motivated each other with my mum and did some gardening, cleaned in the garage...”; Kinga, PL
j. “…strengthening ties with my family, with whom I was actually made to spent time. That how it was in my case. I had some free time to do things I normally did not have time for when the life is concentrated on the University…”, Monika D., PL
k. “…the possibility of getting known yourself better, new hobbies I did not have time for before. Due to the pandemic I tried new things I hope to continue when everything will come back to normality …”, Dominika D, PL
l. “…my cooking skills have improved immensely and I would never ever have had this time to be able to bake and cook and learn new things…”, Tina, UK

Risk of infection

None of the students, no matter what country they come from was not really worried about their own health. There were only two people from English Division who mentioned that issue:
a. “…Due to my eye operation, I was in the risk-zone, so I had to be extra careful..”; Ali, Sweden
b. “…Its troublesome because people in the Tricity area are not treating this as a pandemic anymore. People are openly walking without masks, congregating and life is pretty much back to “normal” …”; Martin, UK
c. ‘...my brother, his wife, daughter and my mother received positive COVID results in the UK and quarantined themselves for 2 weeks…”; “…My father was not with them at the time living somewhere else. They had relatively minor symptoms. My brother felt some flu like symptoms for 2 days and my mother developed a strong cough and some muscle aches. Otherwise everyone else was fine but there was some immense panic amongst family because this was near the start of the pandemic. They tested themselves at the hospital (my brother lives in a secluded neighborhood -so everyone got into the car). They arrived at a special spot where they took swab samples from everyone and PCR testing was conducted to detect COVID. 2 weeks later after their quarantine ended my family received notification from their respective GP’s that they were in fact COVID positive…”; “…The COVID issue has also obviously had a financial impact on me and my family, as my father lost his job…”; “…In the meantime a large majority of my friends are working doctors in Sweden, Germany, USA, UK -and were detailing stories. 2 of my friends were hospitalized with COVID 26 year old and 30 respectively. Their symptoms were pretty severe the 30 year old was actually intubated, the other was on high oxygen airflow -or a state right before intubation. Fortunately both of them got through it….”; Martin, UK
d. “…I first thought the media was overreacting. That was my perspective until my family and friends became the victims of it. Not being able to visit or check on them in hospitals was heartbreaking…”; “… Surprisingly, all those folks I knew who were believed to have strong immunity and rarely fell ill all succumbed to Corona. It was hard to endure and watch those who were at their peak ages of 20’s die and to worsen the situation; some died all alone with no support from family or friends. My buddy in Stockholm opened up to the sister on how painful it was to experience the disease. He was admitted for 2-3 weeks and had to be sedated all through. His fever which kept spiking had to be monitored. Due to the illness, he lost 17 kgs. Sadly, after undergoing that awful experience, he passed away after those two weeks. The dead could not be given a decent burial…”; Ali, Sweden.
In their essays the problem of the virus and the disease was mainly discussed. They did not pay much attention to the e-learning. For both group of students (100%) the health of their relatives and friends especially those staying abroad was very important. They were concerned that in case of disease they can’t help their families:
a. “…I was scared of my relatives health as many of them are older and suffering from general diseases. Thanks God they are all in good health so far …”, Monika D, PL
b. “…My grandmother is 78 years old, in good shape but. that virus can attack anybody. My mum is a teacher and has a home office, but dad? He is going out to work every day. What if he is infected, passes the virus on me and then I will go to my grandmother with some shopping and infect her. I cannot let that happen even though have no influence on that …”; Dominika, PL
c. “…I also was very worried especially during the peak for my sister because she was working front line as a pharmacist and I was worried because she would come home from work every day and my parents would be put at risk also so they decided to divide the house to be as safe as they can because stuck abroad and not being able to help your family or not knowing each day you could wake up to a call or a text message saying that your sister has COVID or your parents was by far definitely one of the biggest fears I had purely because I couldn’t do anything if that happened and the thought of being stuck here alone and not being able to go over in case something had happened would have haunted me for the rest of my life…”; Tina, UK
d. “…the constant worry about my family’s health and the thought that, should something happen to them, I would be unable to go offer my support or be with them. I pray every day for the health of my family, as I cannot even imagine the worst happening with me being in another country, utterly unable to each of them…”, Kate, UK
It is probably caused by the fact, that as a medical student they are more aware than the rest of the society. We can assume that they realize how serious the situation is.

The rapid development of the pandemic COVID-19 and the resulting consequences, the restriction introduced and the increased risk in a specific way affected medical students, especially dental students [2,3,7,8]. Students are considered to be emerging adults, a developmental period that is characterized as an age of identity exploration, instability, and of feeling “in-between” [9]. The current pandemic has already shown significant psychological symptoms related to anxiety, stress and depression in this social group under analysis [7]. Longitudinal studies are needed to analyze the long-term impact of this situation on the psychological state of the students and draw conclusion about the cause and effect between the variables involved [3,4]. In connection with a number of papers presenting student’s surveys [2-5,7-9], the authors have attempted a critical analysis of student’s essays, expecting that the framework questions to form the basis of the studies will allow foreign-language students to freely individualize their answers, which can be compared with the feelings and impressions recorded by students for whom Poland is their country of residence.
During the coronavirus pandemic, students are exposed to a significant number of stressful situations, such as: disturbances in the course of academic classes, reduced social and family contacts, especially in the case of foreign-language students who have remained in the country where they study, away from their families, as in the case in the analyzed group. Limiting academic classes for students of dentistry to online theoretical classes only may cause great concern about the specifics of the study program, which is largely based on practical clinical exercises. Education-related challenges for medical and dental schools, as well as their affiliated hospitals, are significant. It was reported that open communication among students, clinical teachers, and administrative staff would enhance mutual trust and facilitate adequate cooperation at a time of particular epidemic danger [10]. Studies show pandemic, such as COVID-19 increases psychological stress; and the consequences of quarantine lead to emotional disturbance, depression, irritability, insomnia, anger and emotional exhaustion among other health and mental health conditions [3]. Probably, the issues and problems with web-based communication declared by the Polish students were the result of the fact that they did not use internet for on-line communication in their day to day life. What was well known and eagerly done by the foreigners who used that way of communication with their family and friends before the pandemic was announced. In the English Division group there was one student who was a blogger, undoubtedly he was the one for whom it was the easiest to fully use internet and he offered his help to his friends. Both groups were equally scared of problems with the quality of the internet connection, that they had no influence on.
For both group of students the health of their relatives and friends especially those staying abroad was very important. They were concerned that in case of disease they can’t help their families. It may be caused by the fact that both of them had personal contact with the disease in their families. They experienced the risk of COVID-19, death of infected friends or observed their relatives suffering from it. Both of them have professional medical stuff in their families who fight with the disease - in England and Sweden, where, as we know, many people suffered from the COVID-19. It caused that they were more aware of how the treatment and consequences of the disease looked like. Surveys conducted among Chinese students indicated that the public perception of health risks among college students in China presents valuable information on their perception of health risks. Generally, the hazards that were perceived as posing the greatest health risk were those belonging to the social health risks category; items related to technology risks received the lowest percentage [9].
University students played a particularly important role in debates about voluntary quarantines for SARS. In response to an official quarantine of an entire residential building at the Central University of Finance and Economics (CUFE) on April 16/2003, CUFE announced that the university would cancel all classes until May 8. It became the first university to cancel classes and to dismiss students to avoid cross-infection of SARS [4]. Rumors about the closure of all dormitories drove many students home. College students mobilized traditional values such as patriotism and collectivism to call for voluntary quarantines both during SARS in Beijing and at the beginning of H1N1 flu. As grass roots risk reduction efforts, voluntary quarantines aimed to cut off the transmission channel between epicenters and areas affected by epidemics through the use of travel restrictions and voluntary quarantines. Viewed as possible high-risk populations, university students from epicenters took the bottom-up initiative to impose voluntary quarantines in both epidemics, which appealed to the trope of responsible citizens [5,9].
The main differences in the perception of the situation by foreign-language students studying at the University was due to restrictions on mobility and possible come back to their home countries. Like Polish students, foreigners felt particular anxiety about their loved ones left behind in their home countries. A good point of reference for such results may be the situation described in the comparative analysis of the feelings of students from Russia and Belarus, in which different ways of managing the pandemic have been taken [3]. The study results, based on multiple psychological, mental health and substance use factors evidence the impact of quarantine. Overall, students from Belarus universities where there is less quarantine/self isolation restrictions report more positive psycho-emotional conditions than those from Russia [3]. However, research on students and teachers carried out in one of the universities in Pakistan indicates that there is a much greater awareness of the risk among the academic, which leads to rationalization of the problem and has a positive impact on the emotional state even when isolated [11].

The analysis of students essay allowed for a cautious but adequate assessment of the moods prevailing among Polish and foreign language students. The main conclusion proved an awareness of the seriousness of the situation in which students of medical, especially dental faculties found themselves. Concerns were related to the form of further studies and the possibility of taking up employment after graduation. Polish students declared more intense concerns about e-learning and remote study than foreign language students who were more familiar with this form of communication. As in other studies, the authors pointed out to the anxiety prevailing in the health and wellbeing of the family members -both those living nearby and those left behind in distant family countries.

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