A man was walking along a beach where thousands of starfish had been washed ashore. He came upon a boy throwing the starfish one by one back into the sea. When the man asked him what he was doing, the boy explained that he wanted to help the starfish. The man replied, “There are too many for you to make any difference.” The boy picked up another starfish and responded, “It makes a difference for this one.”

Fatima Omarifulo, MPH

This story is the inspiration behind the name of Montefiore Einstein’s Starfish Program. Founded in 2017 by Samuel Sigal, MD, then a hepatologist here, its goal is to help prevent hepatitis B infection from turning into liver cancer in the thousands of people from West Africa who call the Bronx home.

The West African population in the Bronx is approximately 120,000 people and rising. An estimated 10 to 15 percent of this population have hepatitis B, the most common liver infection throughout the world. One in 10 people born in Africa are infected with hep B, as cited in the patient-friendly brochure the Starfish Program distributes to community members.

Two out of three people with hep B don’t know they have it, and one in three will develop serious illness, including cirrhosis and liver cancer.  The Starfish program was designed to combat these trends, and at the helm of its success is division of hepatology patient navigator Fatima Omarufilo, MPH.

For a Unique Patient Population, a Champion They Consider One of Their Own

Omarufilo is the not-so-secret force behind the program’s success. Born in Nigeria, she grew up in Ghana before moving to the U.S. with her family. She started out working in restaurants, got certified to be a nursing assistant, and came to Montefiore as a cardiology technician for 13 years, working full-time while earning her master’s in public health. She joined the Starfish Program in 2019. In 2023, she was named to City and State New York’s “Responsible 100,” a list of New Yorkers serving the common good, in recognition of her work with the Starfish Program.

“Fatima is the New York City champ,” says John Reinus, MD, professor and emeritus medical director of liver transplantation and an expert on end-stage liver disease, who oversees the medical care of Starfish patients. “She has enrolled more patients and ensured they get appropriate care than, I would say, all the other patient navigators in New York City combined.”

She cites their common heritage as a key reason she has earned the trust of the West African community. But she is also persistent. If a community member expresses initial interest in being tested, she calls them personally. “Sometimes the patience and the perseverance that you put in let people understand the importance of what you want them to do,” she says. “I make at least three phone calls to everyone. If the first time I don't get you, I'll call a second time. By the third time, the person will say, ‘Oh my goodness, are you an angel? Anyone going to this much effort surely means I must come in for this test.’”

The Starfish Program recently received the second highest level of 2025 funding from the New York City Viral Hepatitis Initiative, out of 24 programs citywide. It speaks to the program’s success in getting community members tested—those who test negative and are not found to have antibodies are vaccinated, and those who test positive are connected with treatment.

To date, the program’s outreach efforts have reached more than 5,000 people. Of those, 1,000 have been tested and 200 have been vaccinated. When caught early, treatment and monitoring are highly effective in preventing severe disease.

A Multifaceted Approach to Getting Patients in the Door

The program’s outreach efforts often start at the monthly Bronx African Advisory Council, organized by the borough president’s office. Omarifulo shares a 30-minute presentation there periodically, and then leaders of churches and mosques will invite her to present to their congregations. Using religious communities to encourage new patients is a practice started at the Starfish Program by Emmanuel Emeasoba, MD, now a cardiology fellow at Maimonides Medical Center. The Starfish Program also attends community events like health fairs and connects with people who are interested in being tested.

Hypertension and diabetes are also prevalent in the West African community. As an added incentive to come in for testing, the program offers blood pressure cuffs to patients who stand to benefit from monitoring. And it uses the opportunity presented by the visit to do blood pressure and diabetes screenings, and refers patients for follow-up care at Montefiore where appropriate.

After being tested and having a good experience, many patients send their family members and friends. Still, getting people in the door hasn’t always been easy. “Many patients are new to the Western medical system,” says Omarifulo. “Sometimes they are scared. We have to reassure them and build trust.” Having someone from a similar background makes an enormous difference, she says. “The community has shown confidence in me. Almost everyone who expresses interest comes in for testing.”

It also helps that the program’s materials have been translated into French, Twi, Igbo, and Hausa. For patients who are uninsured, the Starfish Program connects them with coverage they are eligible for.

“This group of patients benefits greatly from having more than just someone to order bloodwork, prescribe medications, and tell them when to come for follow-up,” says Dr. Reinus. “A little bit of handholding goes a long way in improving outcomes, and that is what Fatima is able to provide, in addition to the crucial first step of getting people in the door.”

“True to our name, our goal was to save one patient from getting liver cancer,” says Omarufilo. “We’ve done that and more, and we will keep going.”