Radiography students' lived experiences during the coronavirus pandemic: A letter to our peers.

We hope you are doing well. We want to share our experiences as radiography students amid the COVID-19 pandemic in central South Africa. Like infants born during the pandemic, we are also referred to as COVID-Babies because the COVID-19 pandemic commenced in our first year as radiography students. We were on campus for only two months when the South African national alert level 5 lockdown started at midnight on 26 March 2020. Our government instructed us to return home, which for most of us was outside the city where the campus is based. Some of us had to travel between 250 and 665 km to get home, where we went into isolation. We were not allowed to leave our homes for the next three months except to buy groceries or visit a pharmacy or doctor. We were glued to our screens as the news was the only source of information from the outside world. During the COVID-19 pandemic, the virus spread was compared to waves; similarly, we also experienced waves hitting us; this was how waves of fear were initiated in our hearts and minds. This period was when the whole country was under a level 5 lockdown. We were not allowed to leave our homes unless it was to buy living essentials and visit the doctor or pharmacies. Clothing stores were closed, permits were required for travelling, and interprovincial travelling was prohibited. The military was deployed to ensure that people stayed inside their homes. All we could do was stay home and watch our television screens for new information. Every day we would hear about thousands of people dying around the world from the coronavirus, a relatively unknown illness and the effects of which were rapidly transmitted but had no cure yet. It was all distant news until we started losing our loved ones; the anxiety of not knowing who was next was unexplainable. While we were coming to terms with losses and illnesses in our families, an added stressor was trying to keep up with our studies. The university had no choice but to adapt to remote teaching and learning, so we received work and lectures via WhatsApp, Zoom, Teams, and the institution's online learning platform. Online learning could have been more fun and conducive for most, mainly because we were at home. Some of our parents did not understand that we were not home for a visit or on vacation but had to continue our studies. They expected us to assist with household chores. Some of us would attend class while mopping the floors or preparing for supper. Network connectivity was the primary hindrance for those living in rural areas, and we also had struggles with accessing the internet as most of us came from impoverished backgrounds. The university provided us with 20 GB of data monthly to ensure that we could still access the information given by our lecturers. The data provided helped a lot; however, it sometimes ran out before the month ended. It was frustrating to ask for money from family to buy at least 1 GB or even 500 MB to access WhatsApp. Data was expensive and not seen as a top priority during a pandemic, as our parents would instead use the money for food and other living essentials. This made us feel extremely anxious. The study material felt like self-study, as we would be given tasks such as looking up answers in a textbook to questions given via WhatsApp or writing notes on a specific chapter. Straight-forward modules, such as Anatomy, were easier to study compared to more practical modules, such as Radiographic Procedures. As much as we tried to grasp the theory of positioning, it was challenging to visualise what we were studying. We were only first-year Radiography students then, and the most practical exposure we had on campus was learning to position a patient for a chest x-ray. Four months later, in July 2020, the South African national lockdown was downgraded to level 3; a few regulations were adjusted, such as travelling inter-provincially and the reopening of clothing stores. The Minister of Health made an exception that medical students and health profession students who had to obtain practical skills were allowed back to campus as it was mandatory for the curriculum. The university issued permits to all Radiography students to travel and return to campus. At the same time, those in their second, third and fourth years had to continue their workplace learning (WPL) at their respective hospitals. As first years we would still attend face-to-face classes on campus until our rotations to hospitals started later that year. We returned to the outside world, a disease-ridden world full of fear and anxiety, hiding behind our masks and issued travel permits. Every sneeze and cough was an alarming sound and a reminder that the world was not the same as how we had left it when we had gone into isolation. Our class was divided into two groups to ensure we adhered to social distancing regulations. We had different timetables, and the most essential and practical modules we delivered face-to-face, while the other modules continued via the Teams platform. To prepare us for our WPL placement, physical attendance for the Radiographic Procedure module was compulsory. We learned the positioning for imaging the chest, abdomen and extremities, often simulating the positioning while regularly sanitising and wearing our masks. Preparing for midterm exams was very stressful. As part of continuous assessments, we wrote exam-type assessments at the end of each semester. These were our first-ever formal assessments of the work covered during the lockdown period. Generally, we did well in the modules we prioritised and poorly in those we neglected. Luckily because our course uses a continuous assessment model, we were able to make up for those marks through assignments. As time went on, we adapted to the new normal. We happily continued with this way of life until the time came when we were introduced to WPL, where we, as student radiographers, had to attend clinical placement at different local hospitals so we could practice what we had learned in class. Before we were placed, we rotated the different local hospitals and experienced working with actual patients. We were orientated and given a set of rules of what to do and not do when we finally entered the x-ray department. Throughout the rotation, we were chaperoned by either a qualified radiographer or a senior student whom we shadowed and watched as they worked. Some even allowed us to position patients for chest x-rays while they supervised. We did rotations in private as well as state-owned hospitals. There was such a shocking difference between the two, as we saw how the privately owned hospitals had much better facilities than the state-owned hospitals. Yet, sadly the state-owned hospitals had an increased number of patients. After the initial rotations, we were placed in different local hospitals. This was where the final and largest wave of fear hit like a cold splash of reality as we saw how severely the COVID-19 pandemic had affected the world. Day in and day out, we would see patients either walking in to get tested for COVID-19 because they were experiencing minor symptoms or were already bedridden in intensive care units because of COVID, fighting for their lives. The worst thing about this virus was that the symptoms differed from patient to patient. For some patients, it would resemble a mild cold; after ten days, they would be healthy again. However, some were not so lucky and would be admitted to hospitals for weeks and months, and some would not survive. In addition, qualified and student radiographers had contact with COVID-19-positive patients as they received chest x-rays and computed tomography scans. This imaging was to assist physicians in diagnosing the virus and provide more discerning information on the exact impact of the infection on the patient's respiratory system. We learned how to practice as radiographers under COVID-19 regulations. We take infection control seriously and take the necessary measures almost four years later. Our biggest motivation to abide by the rules was the awareness of what impact COVID-19 had when looking at the chest x-ray images we took. Sometimes, a patient would come to the department for imaging, and only after the examination; would we learn that the patient had tested positive for COVID-19. Even though one, as a radiographer, would practice all necessary safety precautions, it still did not dispel the anxiety and fear that would boil up inside us, not knowing whether we could have possibly contracted the virus. Then there were times when our colleagues contracted the virus, and we would see firsthand or hear how sick they got. We even had a colleague in the intensive care unit for months because her blood oxygen saturation levels were dangerously low. It became routine to wake up daily and go to work, feeling stressed and anxious because we never knew if we'd be next. This state of the world and our daily environment drained our emotions and our bodies were battered and bruised, but day by day, we showed up. We witnessed and experienced severe burnout from physical, emotional, and mental exhaustion caused by long-term involvement in mentally and physically draining situations. For our undergraduate research project, we were inspired to research the burnout experienced by diagnostic radiographers globally and the impact of the COVID-19 pandemic on increasing the burnout rate. The little we learned about infection control in class helped a lot regarding COVID-19. The lecture about a 'dirty' and a 'clean' radiographer also helped when we took mobile x-rays. We knew that one radiographer had to handle the machine, and the other had to handle the patient. Personal protective equipment (PPE) was accessible in all hospitals, but it was more readily available in privately owned-hospitals than in state-owned hospitals. Although formal training on how to use PPE correctly was not provided, our knowledge about infection control came in handy. We knew where and what not to touch, how to discard the PPE and what to do after handling a COVID-19 patient. We are fortunate today because every health and science professional has worked tirelessly to manage the pandemic. As a result, scientists developed vaccines and healthcare workers were given top priority to be vaccinated. At first, the thought of getting vaccinated also added to our anxiety because of the ongoing debates surrounding vaccines. Conspiracy theories were mainly opinions from people on the internet and social media, based on how fast researchers had developed a vaccine that was not yet proven 100% safe. We also battled to comprehend why healthcare workers in Africa were among the first to receive the vaccines, despite other continents, such as Europe, having experienced the effects of the COVID-19 pandemic more severely at that stage. Many of us were confused and anxious as we did not know which posed the greater risk, the vaccine or the virus; however, as healthcare workers, we were propelled to get vaccinated. It was a matter of which risk to take, and most of us took the vaccine route. The conspiracy theories were scary, but COVID-19 was scarier. We had seen people die; we had watched people's health deteriorate until their last day; honestly, the vaccine seemed a better option. Since then, the world has slowly grown into a new normal after COVID-19, but all the lives lost and sacrifices made remain with us. We have yet to determine what the future holds for us, but we believe our country is better equipped to take on the coming days and future challenges. We learned from this experience that it is crucial to adapt even in uncomfortable situations. For example, being confined to our houses for months allowed us to find new hobbies, ways to deal with stress and, most importantly, spend quality time with family and loved ones. Sharing our experiences privately with peers who fully comprehended the severity of the situation assisted us in taking on each new day. This has been a big part of our professional relationship as a class, especially as a research group. Our personal and professional growth has been a rapid response to our situation. Hard working colleagues and staff at the hospitals mentored us and lecturers did their best to keep us informed, aware and supported. Sharing our worries with our lecturers helped us and students were referred to the university's Wellness Centre. Prayer sessions were a great comfort to many. If we knew then what we know now, we would have relaxed more. We would have taken each day as it came without worrying about the next day, as we had no control over what happened next. We would have trusted experts more than listening to conspiracy theories. If we knew then what we know now, we would have been less anxious and fearful. We hope that as you read this piece, you take comfort in the fact that we all went through the same waves of anxiety during the pandemic regardless of our age, ethnicity, country or social-economic background and survived. Do take care of yourselves, mentally and physically. Yours sincerely 2023 Fourth-year Radiography students (COVID-Babies)