There is no doubt that Hong Kong is going through an identity crisis. Those who have had teenage children will appreciate the mood swings and the irrational emotionality of the conflicted child; anxious to grow up but reluctant to face the reality of adulthood. I came to Hong Kong two years after the handover/return of the territory to mainland China. Economically things were not so bright, but politically Hong Kong residents were still delighted with their new freedom from British colonial rule. Now we are in 2012 and the fateful 2047 seems not so distant anymore. As the territory moves inexorably towards full reunification with mainland China, the days of British rule are increasingly being referred to in nostalgic terms.

There are many problems, and things came to a head recently when some local Hong Kong people were trying to take photographs of a shop display in a busy Canton Road in Tsim Sha Tsui. It was unfortunate because a security guard employed by the shop rushed out to stop the photography. Strong words were used by both sides, and the conclusion of the exchange was that local Hong Kong people were not welcome to take photographs, although mainland tourists are. This was enough to open the floodgates of resentment and prejudice that has built up over the past few years. Already there are concerns with heavily pregnant mainland mothers apparently sneaking into Hong Kong in the backs of vans in the dead of night in order to give birth in Hong Kong hospitals.  The benefits of excellent healthcare are matched with the right of abode for the baby. As the auspicious Year of the Dragon approaches the problem is only expected to get worse. The government has tried to cap the number of births in both private and public hospitals, but the flood gates have been opened.

But there is more. The increasing economic prosperity of mainland China means that Hong Kong is now being “invaded” by mainlanders who are buying up the housing, buying up the luxury goods (including, of course, the iPhone 4s), and emptying the supermarkets and chemists of basic commodities. With so many concerns about food products in the mainland, items such as baby milk powder processed in Australia, Europe, or America are being bought up in the same way as the UK citizens used to buy wine from France.  Bulk purchase.

Life in Hong Kong is as exciting and as challenging as ever, but the opportunities are changing.  After years of exploiting the mainlanders, the mainland Chinese are now exploiting Hong Kong.  This is not a bad thing if the service minded territory refocuses and takes advantage of the new opportunities. We can see this in medicine where the local medical politicians are still trying to restrict the entry of overseas medical graduates from working in Hong Kong. The influx of mainland mothers is increasing the demand on neonatal care services and these are at present under staffed and underfunded. There is a desperate need for overseas trained doctors to prop up the shortfall in local staff. One problem with the present medical and political system is that once a mainland mother gives birth (for a fee) in a private or public hospital, the baby (now a Hong Kong citizen) is entitled to the heavily subsidized neonatal care, if it is available.

So Hong Kong has a number of hot potatoes, and the perception of the wealthy mainlanders buying up property and basic commodities needed by the Hong Kong taxpayers is one. The apparent exploitation of the publicly funded health service is another.

This is a year when a new chief executive is to be elected, and how they manage these critical issues may well define the future of Hong Kong as a city of relevance in the Far East.

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.