they are just ignorant. I was riding on a shuttle bus with a peace corp kinda hippie dood who was telling me how wonderful and advanced cultures are in third world countries he had been to. He was so proud of his work helping them get potable water. I asked him why after thousands of years they haven't learned not to #$%* upstream and get water downstream. Or crap in a hole in the ground to prevent disease. He couldn't answer that.
Well, anyway good for him for helping.
The problem is they have very little surface water. What that guy was doing was working on a project to drill wells which gives them clean water and cuts the rate of disease since they have to use stagnant puddles. It is the cheapest type of aid they can give them.