"In their lives, so many things are out of their control: where they will get clean water, how they’ll send their children to school, what they’ll do if their wife has a complicated pregnancy."

What I have found strange in your experiances is the many instances where people PASSED on an opportunity for control. A little extra work to get Funding for an SPA project. A little forsight to avoid a problem, choosing to have less children, CHOOSING not to drink and miss work etc. I would say it is almost a case of "In their lives, THEY BELIEVE so many things are out of their control...." They have hardships I can't imagine, but for some it appears the CHOICES they make where they MIGHT excersize control continue to rule their existance.