> and the problems are massively overblown
For all the places I have worked in and visited through my life, including poor countries in Africa, Europe, Russia, and places as extreme as Afghanistan, the only place I have ever seen someone openly defecate in the street is San Francisco. And I've seen it many times in San Francisco.
It's not overblown. Your reference points have been distorted. It's not normal. People don't do that in other cities.