There is a specific utensil found in the kitchen of all Chinese homes; a finely balanced rectangular blade with a keenly sharpened edge that is used for peeling and parring, slicing and dicing, skinning, deboning, gutting and cutting but most of all, chopping.

This is the Chinese chopper that figures in Chinese culture in a way that extends far beyond the kitchen.  Traditionally the chopper is used in the processing of settling territorial disputes or restoring face amongst the Triads (Chinese criminal organizations). Chopper attacks would include the amputation of digits, the scarring of faces and various forms of musculo- tendinous injury to render temporary or permanent incapacity.  In Hong Kong such chopping attacks rarely affect the expatriates.  Indeed the last case was in 2007 when Ben Ford, a temporary barman in a club during the celebrated Hong Kong Rugby Sevens, was attacked in a case of mistaken identity.  Ben was pulled from a car and had two fingers amputated and limbs slashed with choppers smeared with human excrement.  Fortunately help was immediately at hand and the assailants were driven away.  The amputated fingers were retrieved and Ben (plus fingers) was rushed to a nearby hospital.  The skilled and practised Hong Kong hand surgeons replanted the fingers with a good result.

However not all chopper attacks are associated with the criminal elements.  Last weekend in Hong Kong a 42 year old man left his New Territories home, chopper in hand and embarked on a frenzied attack on his neighbours that left two people dead and three critically ill in hospital.  This man had a history of mental illness. The challenge of appropriate care in the community of those with a history of mental illness is one of global concern.  Meanwhile, yesterday, in the Mainland China a “knife” wielding 48 year old villager hacked to death seven children and two adults in a private kindergarten.  This is actually the eighth reported attack on children in Mainland schools in as many weeks. I understand that in Chinese script the distinction is not made between a knife and a chopper but it is likely that these were also chopper attacks. The full details are unclear but not all cases are thought to be associated with mental illness.  Some commentators are talking of the widespread hopelessness amongst the underprivileged “because of rampant and institutionalised social injustice.”  We read of reports of school security guards being armed with pitch-forks and pepper spray. Meanwhile in Hong Kong the hospital authority is responding to the challenge of community care by setting up a network of support workers.  Funding has been allocated but there is a critical shortage of trained and experienced staff.  The work of the psychiatrists is extremely challenging and there is an almost impossible balance to be achieved between incarceration on the one hand and freedom on the other.  At present the public mood however, as expressed in the media, is veering towards incarceration (of a few) to achieve another freedom (for the majority); freedom from fear.

Andrew Burd is professor of plastic, reconstructive and aesthetic surgery at the Chinese University of Hong Kong. His major clinical interests involve paediatric burns care and the role of plastic surgery in the palliation of advanced malignancy. Academic interests include pragmatic ethics related to the practice of medicine including research and publication.