'They seem to have almost nothing yet are very content'

But the structure was not the only problem.

The main one was that this hospital, which saw between 1500 and 3000 people pitching up on a daily basis, didn't have a proper A&E system at all.

Klaassen points at the photograph of people crowded in a dark, shed-like room.

"These people are unwell," he says. "They've no one to prioritise them. While they are waiting, they have no treatment. For some that's too long."

Over the past three years, Klaassen, an A&E consultant at Ninewells, Dundee, has been working with the Malawian hospital to introduce "globally tried and tested systems".

"When you attend an A&E department," he says, "you have to be triaged, to be prioritised on a need-to-be-seen basis."

In Blantyre that wasn't happening. On an average day at the Queen Elizabeth Hospital they see 10 times what would be seen in a major Scottish city-based A&E department: 10 times, for instance, the 150 patients Ninewells sees on an average day. But up until 2012, Blantyre had no system for processing them. Some people waited. Some bribed. Some died.

Klaassen's connection with Malawi began in 1987 when he was a medical student and did a 10-week elective there, divided between Blantyre and a rural mission hospital. The desire to go back has never left him.

He has watched Scotland's links with Malawi expand and seen Jack McConnell create a special partnership with this, one of the world's poorest countries when he was First Minister.

"You know," the doctor says, "it's an amazing country, amazing landscapes, lovely people. They seem to us, who are resource loaded, to have almost nothing and yet be very contented." Even while he was there as a student, he had the feeling he would return.

Klaassen is proud of the link Scotland has with Malawi. "It is one of the poorest countries in the world. But it's got this connection with Scotland, and party politics aside, that has been significant.

"For a country of five million people to give the international support Scotland gives to Malawi is massive. If every country in the world adopted somewhere like that, the world would be a much better place."

It was only a few years ago his connection with Blantyre was revived. A colleague persuaded him to go to the Queen Elizabeth and deliver some training.

While he was there, he said, he was "hijacked by the people I knew from years ago". They had done great work in the intervening time, and had set up a paediatric emergency department, but as yet, there was no provision for adults.

Would he be interested in helping? When he proposed the project to his team at Ninewells he was surprised how unreservedly enthusiastic they were. He has had particularly strong support from lead nurse Gwen Gordon.

Although the systems they put in place were the same as those at Ninewells, the pattern of disease, illness and injury was different. Malaria, cholera, tuberculosis - all diseases we see rarely here - are common there.

Klaassen clicks through a series of photographs of cases he saw. A man lies rigid, his lips stretch into a taut grin that tells us he has tetanus. He died days after that photo was taken.

Another shows the kind of suffering that could have happened almost anywhere. A young woman, face horribly swollen, badly beaten, appears in one photograph. She was found, he says, in her flat like this, and, was thought to have been lying there for three days. "She didn't survive. The team managed as best as we could."

In Malawi, there is also the huge burden of HIV and Aids. "Something of the order of 70% of all medical admissions are HIV positive," says Klaassen. "So in some way their admission is related to that disease process. However, it's worth remembering Aids is not a death sentence, and it's not a death sentence in Africa."

Much has changed since he first went to Blantyre. There was, he recalls, back then very little in the way of resources anywhere, very little westernisation. Now there is a Kentucky Fried Chicken and a mobile phone network "with coverage in the most amazingly remote places".

Klaassen recalls that 25 years ago there were hardly any cars but now the roads are choked with traffic jams. With that has come an increasing amount of accidents, creating all the more need for a major emergency department.

Through their work setting up the department, Klaassen is sure his team has drastically cut death rates When a similar children's A&E was set up at the hospital in 2001, it cut the death rate from 19% to 9%, later going on to reduce it to 4%.

Klaassen is sure something similar is happening. "One clinician came up to me, " he says, "and said, 'My ward had on average five deaths a day. I now have one every other day'."

The system was not without its teething problems. There was a certain level, for instance, of corruption: people slipping a bit of money to clinical officers to be seen quickly. That culture, he says, has not gone entirely but it has been clamped down on.

The connection between the two hospitals is more than just a teaching and mentoring one. Ninewells also sends out equipment to Blantyre. "We squander so much stuff because of rules about infection control," says Klaassen. "There, they make do and mend. But we're such a throwaway society."

He illustrates using crutches, which nowadays are no longer recycled in the UK but thrown away after one person has used them. "It's barmy. And in Malawi, people come in carried on people's backs. So we sent a whole load of crutches out."

His urge to help, he says, is more driven by the feeling "that you should do something where you can" than "tub-thumping zealotry". As he scrolls through his photographs - on safari, drinks on the veranda, eating out in restaurants - he recalls his days off with his wife and 16-year-old son, who visited this year, and notes: "It's not all self-deprivation and whip yourself. We add our bit to the economy."

Neither of Klaassen's parents, who ran a business in Lancashire, worked in medicine, although his Dutch grandfather was a ship's doctor. He jokes maybe he was found under a bush and taken in, so little does he have in common with his siblings. But he leaves little doubt he loves his field.

"A&E is the last great generalism," he says. "It's general practice with teeth. And you treat everyone from the wino who is down-and-out to members of the royal family and everybody in between."

For him, that included George W Bush, following the US President's fall from his bike when he hits a Scots policeman at the G8 summit in Gleneagles.

Klaassen hopes the Blantyre A&E is just the beginning.

The Minister of Health for Malawi agrees. He met her on his last visit and he says: "She left us with no uncertain terms she wants this as a priority to roll-out."

This project, then, is a pilot for a much more extensive scheme. Money, of course, is the obstacle, and he is currently on the hunt.

"We need sponsorship. We've spoken to the Scottish Government and we've got a grant but we're going to need a big donor. I'm hoping a big foundation will come in."

He relishes the idea of going back to finish what he started. "We want to help spread the model we developed for Blantyre so every hospital in Malawi has a front door that's fit for purpose."