New Zealand is in the depths of the South Pacific, a country with a population of four million people. One million of the New Zealanders, or twenty five percent of the population, is really impoverished. It was this portion of the population that Dr. Wagner cared for while he worked and lived there for a year working in the South Auckland Health District.
There is an inordinate amount of ear disease in New Zealand among the Maori, Pacific Islander immigrants, and other third world immigrants to New Zealand. The WHO stated that if there is greater than 4% middle ear disease, there is a massive public health problem. The amount of ear disease in New Zealand exceeds 10%.
The cultures of the South Pacific, including the Maori of New Zealand, have been isolated geographically from the rest of the world. As a result they have immature immune systems and are thus subject to greater risks of infectious diseases.
One of the strengths of the health system in New Zealand is their public health service. There is a program that is engaged in teaching public health nurses the basics of ear disease and how to make the correct diagnosis and referral to ENT. Nurses visit public schools and screen for ear disease on a daily basis.