Sandra has been active in the public health arena for more than 20 years, 16 of which have been devoted to international health, working in conflict-affected settings including Thailand, Haiti, Colombia, Croatia and numerous countries in sub-Saharan Africa. She has conducted needs assessments in many emergencies, including in Chad, Indonesia, Thailand, Colombia and Zambia, and advocated the findings to donors, government and United Nations representatives, staff of humanitarian agencies and refugee communities. She has also established health programs for refugees and internally displaced persons in many countries, including Malawi, Somalia and Sudan. She was a country director in Malawi. Sandra established the health unit and worked as the International Health Advisor for six years at the headquarters of a leading humanitarian response agency.