Keeping their own and integrating the other: medicinal plant use among Ormurs and Pathans in South Waziristan, Pakistan

Abstract

Background

In multicultural societies, traditional knowledge among minorities faces several challenges. Minority groups often face difficult situations living in specific peripheral geographies and striving to retain their biocultural heritage, including medicinal plant knowledge and practices. Folk medicinal plant knowledge is a dynamic eco-cultural complex influenced by various environmental, socio-cultural, and political factors. Examining medicinal plant knowledge among minorities has been an increasingly popular topic in cross-cultural ethnobiology. It also helps understand the dynamics of local/traditional ecological knowledge (LEK/TEK) change within a given community. The current study was designed to investigate the status of medicinal plant knowledge among two linguistic groups, i.e. Ormurs and Pathans, living in a remote valley of West Pakistan.

Methods

We recruited 70 male study participants from the studied groups for semi-structured interviews to record the medicinal plant use of their communities. Data were compared among the two studied communities using the stacked charts employing the presence or absence of data with Past 4.03 and Venn diagrams. Use reports (URs) were counted for each recorded taxon.

Results and Discussion

A total of seventy-four medicinal plants were quoted as used as ethnomedicines by the researched communities. Most of the reported plants were used to treat digestive and liver problems. The cross-cultural comparison revealed a considerable homogeneity of medicinal plant knowledge (the two groups commonly used more than seventy plants); however, comparing uses recorded for the widely utilised medicinal plants showed numerous idiosyncratic uses among Ormurs but very few among Pathans. Ormurs reported a higher number of cultivated, wild, and imported plant uses than did Pathans. These results indicate that, compared to Pathans, the Ormur linguistic minority retain more folk medicinal plant knowledge, which may be explained by the fact that they have incorporated different folk remedies: their “own knowledge” plus that of Pathans, with whom they have lived together for centuries. Moreover, the local plant nomenclature among Ormurs was highly affected by the plant nomenclature of Pathans.

Conclusion

The current study revealed that living together for a few centuries has not implied sharing plant knowledge (as the Pathans do not seem to have learnt from the Ormurs) or, in other words, that plant knowledge exchanges have been unidirectional. The findings show that the Pashto dominant culture may have possibly put pressure on the minority groups and affected local plant-centred cultural practices, as we see in the case of local plant nomenclature hybridisation among Omuri speakers. Hence, it is imperative to employ diverse educational strategies to revitalise the decline of medicinal plant knowledge in the studied communities, especially among Ormurs, who need more attention as they face more challenges than the other group. Locally based strategies should be devised to restore the fading connection with nature, which will be advantageous for revitalising plant knowledge.

Background

In multicultural environments, minority groups adopt the dominant way of thinking, practising, and behaving. Being part of the system, cultural knowledge, including local plant knowledge, is also impacted and subjected to change in multicultural societies [1]. A few researches have shown that sharing local plant knowledge among different cultural groups is often a phenomenon of cultural assimilation and standardisation towards the dominant cultures (see, for instance, [2,3,4,5]). Cultural assimilation is triggered by historical, political, and religious pressures, resonating in the daily practices of local communities. As a result, the attached local plant knowledge and its transmission are also greatly affected.

Field ethnobotanical studies across Pakistani Hindukush have revealed that local ecological knowledge related to both medicinal and food plants is highly threatened among the local communities, including minority groups [3,4,5,6]. Moreover, in multicultural environments, language vitality among minorities has been severely affected by sociolinguistic adaptation (see, for instance, [4, 6]). It has been claimed that the erosion of the vernacular names of plants among minorities may indicate the decline or homogenisation of traditional or local knowledge within each minority group. For instance, a study conducted in Kaniguram among Ormurs and Pathans revealed considerable homogeneity in using wild food plants (WFPs) [6]. In addition, our research has indicated that Ormurs have adopted the local Pathan names of many WFPs, as Pashto is spoken as the lingua franca in the study area. Ormurs are a cultural diaspora from the Middle East that arrived in the area during the eleventh century and represent a tiny minority group living in the small valley of Kaniguram in South Waziristan (see [7, 8]. Their language is highly threatened [9]. Given the [6] results, we have conducted a cross-cultural ethnomedicinal study among Ormurs and Pathans to identify the patterns of knowledge distribution of medicinal plants among the two communities. The food ethnobotanical study conducted among the two groups revealed that knowledge of WFPs is primarily shared among the two communities; however, the dynamics of medicinal plant knowledge transmission are not the same as for WFPs [10]. However, medicinal plant knowledge is shaped in a particular way within a given cultural group, which certain factors could influence. Therefore, it stands to reason to investigate the patterns of medicinal plant use among Ormurs and Pathans as we think that the knowledge and practices of these two groups may differ [11].

In a broader sense, cross-cultural study will help to understand how local or traditional plant knowledge evolves and is reshaped among different cultural groups [12,13,14,15,16,17]. Thus, a cross-cultural analysis might provide a reflection of the spatiotemporal changes in past plant uses, which can be used to establish and interpret the results in a historical context, as Olsson and Folke observed [18] that the specific characteristics of traditional ecological knowledge (TEK) lie in its “historical and cultural continuity of resource use”.

It is important to note that this study is the very first scientific investigation in North and Western Pakistan that takes into account sound ethnobotanical standards to study the local plant knowledge on medicinal plants to provide better scientific interpretations for future research work regarding the sharing of knowledge of medicinal plants across different cultural groups, including minorities. In the region, hundreds of studies have already been carried out in the past decades to document the therapeutic uses of local plants (see for reference: Journal of Ethnopharmacology, Journal of Ethnobiology and Ethnomedicine, Frontiers in Pharmacology, Plos One, and many other international and national journals); however, we have often observed vague scientific data interpretations made in these studies, and a few of these researches do not even follow some of the essential ethnobotanical standards recommended by ethnopharmacologists (see [19, 20]).

We have therefore conducted a cross-cultural ethnobotanical study with the hypothesis that the medicinal knowledge of Ormurs may have been impacted by their nearby Pathan neighbours, which led us to formulate an overarching research question regarding the vulnerability of the Ormuri ethnomedical system due to a possible homogenisation imposed by the dominant Pathan group. Ormurs and Pathans live close to each other and share marriages, values, cultural richness, and knowledge of daily life practices.

The specific research objectives of the study were:

• 1. To document the plants’ local names and medicinal uses among the two linguistic communities;

• 2. To compare the medicinal plant reports among the two groups.

Materials and methods

Study area and ethnic groups

The present study was conducted in Kaniguram, located along a sloping hillside in South Waziristan, Pakistan (Fig. 1). The study area is populated by two ethnic groups, i.e. the Ormur diaspora and Pathans, which have lived together for centuries. Pathans are the dominant ethnic group with their distinct cultural heritage, attributed to their specific traditions, customs, and Pashtunwali—the Pathans code of life. In Kaniguram, Pashto is spoken as the language of communication or the lingua franca, while Urdu is the primary language officially used in schools and administrative offices.

Fig. 1

Map of the study area

The ancient Ormur diaspora is a distinct linguistic minority that originated in the Middle East in the eleventh century. Khattak [21] reported 10,000 speakers of the Ormuri language in the study area, and now the number could be more than that. Traditions relate that Ormurs may be the descendants of Persians, Arabs, Kurds, or Afghans [7, 22, 23]. It has also been stated by some authors that Ormurs originated from the southern shores of the Caspian Sea in Persia and migrated to the south-eastern part of the Iranian territory relatively recently [24], while other viewpoints suggest they represent Indigenous communities that occupied lands south of the Hindukush from time immemorial. Their language, however, is the only surviving representative of a south-eastern subgroup of Iranian languages [7, 23, 25, 26]. Captain Leech [8] stated that the Ormur were included in the general term Parsiwan or Tajak and could have arrived from Yemen. Sultan Mahmud of Ghazni might have brought them, as they were part of his army when he invaded India in the eleventh century. The Ormur people were highly instrumental in removing the temple’s gates of Somnath [7, 8]. Later, after conquering the temple, the army returned to Afghanistan. While on their way, some of the Ormur soldiers settled in Kaniguram as they found the valley a suitable place to live. For further details, see our article [6].

Post-conflict social change

The “war on terror” in Pakistan, specifically in the Waziristan region, has significantly impacted the local population, including the people’s traditional plant knowledge. The war started in 2004, and the security situation remains highly fragile. The ongoing conflict has resulted in the large-scale displacement of people, the destruction of infrastructure, and the disruption of livelihood activities. Because of the displacement, many people have lost access to their traditional lands and resources, which has resulted in a loss of knowledge about local plants and their uses. The destruction of infrastructure has also had an impact, as many traditional medicinal practitioners, who were the custodians of this knowledge, were forced to flee their homes, and their knowledge was not passed on to the next generation.

Additionally, the militarisation of the area has limited access to the land, which makes it difficult for people to continue their traditional livelihood activities such as agriculture, pastoralism, hunting, and gathering, which are closely linked to their traditional plant knowledge. One crucial aspect is the linguistic erosion among Ormurs and the adoption of the Pashto language as the lingua franca. The large-scale outmigration has impacted the language as well.

Vegetation and environment

Kaniguram, located in the upper part of South Waziristan, is a Valley surrounded by hills and rugged mountains. It is a town at 32° 31′ 7ʹʹ N and 69° 47′ 11ʹʹ E. The climate is Humid subtropical. In winter, the valley is covered with snow. The winter is extremely severe, with the coldest months from December to February. In summer, the temperature is moderate. The average annual rainfall is 6 inches, while the summer is relatively hot in plain areas. Kaniguram is located at a high elevation in South Waziristan, where vegetation cover is mainly composed of Quercus spp., and at even higher elevations, Pinus gerardiana Wall. ex D. Don, Pinus wallichiana A. B. Jacks., Cedrus deodara (Roxb. ex D. Don) G.Don, and Abies pindrow Royle are the common botanical taxa [27].

Field survey

Ethnomedicinal fieldwork was carried out by the first and the second author in 2021 (October to December) and 2022 (July to August). Data were gathered through semi-structured interviews with elderly community members (aged forty-five to ninety years) among the two linguistic groups. The study participants chosen for the survey have a long-lasting relationship with the natural environment and the local flora and were recognised as experienced in local medicinal plant knowledge. Male field researchers co-authoring this article recruited male study participants in the interviews since female informants could not be approached due to cultural/religious issues. Moreover, it is also important to note that our respondents were not traditional healers or doctors but laypeople, i.e. experts in local plant knowledge who gained it orally from their elders. In the particular social and cultural context of the study area, not even women researchers would be allowed to freely approach and interview female study participants in the study area. We strictly followed the Code of Ethics of the International Society of Ethnobiology [28] while conducting the interviews. Prior oral consent was obtained from each of the participants before each interview. Seventy male participants were selected for the study, including 35 from each linguistic group. The interviews were conducted in the Pashto language, which is spoken as the lingua franca in the study area. To each participant, we explained the topic and objectives of the study.

We adopted a mixed approach for selecting the informants. The survey started with participants selected through random sampling, and then, once we became familiar with the study area, we adopted the snowball technique. The duration of the interviews varied, i.e. in some cases, it ended after 20 min, while in others, it lasted for hours. Only participants with long experience with nature and who remained in the study area for decades were chosen. Interviews were conducted in public gathering places, local shops, and fields, mainly after prayer near mosques where both linguistic groups gather and interact. Some people were also interviewed while working in fields. The information collected from the interviewees focused on the local names of medicinal taxa, parts used, diseases treated, and modes of preparation and application. Free listing was used to obtain a thorough knowledge of the therapeutic uses of the quoted plants. Initial free listing was attempted, but it was usually short and rarely succeeded. After that, plant remedies used for different emic disease categories were asked about, following a mind-mapping system, starting with ailments of the head (headache, cold, ear and eye diseases, sore throat, etc.) and internal organ diseases (stomach, heart, lungs, kidneys, etc.), followed by systemic disorders (joint diseases, diabetes, allergies, cancer, immune system disorders), skin-related diseases and injuries (cuts, wounds, furuncles, rush), culture-bound diseases (evil eye, nightmares, etc.), and lastly any other treated illnesses not yet named. If some of the plants included in free listings were not mentioned, the respondents’ attention was also guided to those. We also asked interviewees to provide a date for the first and last use of the plant as precisely as possible to identify when it was used. We also took some photographs and received consent to publish them if deemed necessary in the publication process.

Identification of plants and botanical nomenclature

The recorded botanical taxa were identified in the field by the fourth author, and the specimens were assigned accession code numbers and then deposited at the Department of Botany, University of Swat, Pakistan. The botanical nomenclature was verified using the World Flora Online database [29].

Data analysis

Data were arranged in MS Excel, and use reports were counted for each quoted taxa. Associations between plant species and the diseases treated were evaluated via stacked charts, employing the presence or absence of data using Past 4.03 across the two selected groups. The collected botanical data were arranged into two binary trends for each community, and the data were compared through Venn diagrams. Bioinformatics and Evolutionary Genomics software was used for cross-cultural comparisons between ethnic groups (https://bioinformatics.psb.ugent.be/webtools/Venn/). The International Classification of Primary Care, 2nd Edition (ICPC-2, updated March 2003), was used to categorise all diseases and treated ailments. Emic disease names were correlated with this classification system’s medicinal categories (hereafter, etic disease categories).

Results and discussion

Medicinal plant use and quantitative analysis

We recorded a total of seventy-four medicinal plants that were quoted by the two ethnic groups in the study area. A complete inventory of the listed plant taxa is provided in Table 1. The plants were mentioned for treating various diseases, which we grouped into fifteen etic categories (Fig. 2). The dominant plant part used was fruit for both of the researched groups. The reported species belonged to thirty-nine botanical families, the most prevalent of which were Amaryllidaceae (5), Lamiaceae (5), Cucurbitaceae (4), Apiaceae (4), and Fabaceae (4); 3 or fewer plant taxa represented the remaining families.

Table 1 Ethnomedicinal uses of plants quoted by the two studied communities

Fig. 2

Stacked chart showing plant species used to treat various diseases among Ormurs (a) and Pathans (b) in the study area; the abbreviations refer to the first three letters of both the first and second part of the Latin binomials

The Ormur community reported medicinal uses for all of the quoted plant taxa belonging to the thirty-nine families, with the dominant families being Amaryllidaceae and Lamiaceae. In contrast, the medical ethnobotany of Pathans consisted of only fifty-two species distributed across thirty-four families.

A large number of plant species were used for digestive and liver problems. We observed that Allium sativum (12 URs) and Apteranthes tuberculata (6 URs) were the most commonly used taxa to treat these ailments. Other essential disease categories included genital and cardiovascular problems, which were treated by many plant species. The prevalence of these two different kinds of diseases could be because they are common in the study area, or medicinal plants are more useful and have potent activity against digestive problems. We may assert that traditional herbal therapies may play an influential role in treating digestive tract problems, as they are the target of valuable activity [30]. Some of the most important and commonly used plants included Withania coagulans (33 URs), Piper nigrum (33 URs), and Thymus linearis (32 URs), Olea europaea subsp. cuspidata (31 URs), Allium sativum (26 URs), Mentha longifolia (26 URs), Ficus carica (24 URs), Vitis vinifera (22 URs), Polygonatum verticillatum (20 URs), Punica granatum (20 URs), Teucrium stocksianum (21 URs), Pinus gerardiana (19 URs), Nasturtium officinale (18 URs), Quercus baloot (18 URs), and Apteranthes tuberculata (16 URs). The large number of use reports for the taxa mentioned above indicates the cultural acceptability of these taxa across the two groups.

Sixty-eight taxa processed as herbal therapies were taken orally, while the remaining six were applied topically to treat skin diseases. Some plants were perceived as effective in treating COVID-19, which indicates how new plant uses emerged during this emergency and how this novel knowledge rapidly circulated across the communities. We have also provided the correspondence between emic disease names and etic disease categories (Table 2).

Table 2 Correspondence between emic disease names and etic disease categories and their frequency of mention

Some of the used plants were spices or condiments that were store-bought, such as Allium sativum, Coriandrum sativum, Curcuma longa, Ferula assa-foetida, Piper nigrum, and Zingiber officinale. These spices and flavouring agents have been medicinal since the Middle Ages [31]. It has been stated that the spices are both grown in the Middle East and imported from Africa and Southeast Asia. Their trade may be a legacy from Roman times, when black pepper, ginger, turmeric, and cardamom were transported from Southeast Asia into the Mediterranean via Arabian incense trade routes [32, 33]. Plant availability is a crucial factor shaping traditional plant use. Participants also quoted several fruits that are available in the local market. Some of the plants bought from the market or “Pinsar” shops are collected in other regions of North-West Pakistan, especially Upper Chitral and Gilgit-Baltistan.

Differences in plant availability between rural and urban contexts may also account for the differences in the plant lists reported in this study and the published literature. In the current survey, 40 plants were collected in the wild, and eight were cultivated. At the same time, 26 were bought or imported, which indicates that the knowledge of the studied communities is quite heterogeneous and likely to have been acquired from outside the region. The cross-cultural overlap among the different medicinal plants having different origins is presented in the next section.

Cross-cultural analysis

The cross-cultural comparison revealed considerable overlap in the use of plants among the two groups (Fig. 3a); however, we observed a higher ratio of heterogeneity among the uses of commonly reported plants (Fig. 3b). Pathans exclusively quoted a few uses, while Ormurs have retained several idiosyncratic medicinal uses for the respective plants that make their contemporary medical ethnobotany different from that of Pathans (Fig. 4a). These results suggest that Ormurs may have retained a strong attachment to their original traditional medical system despite being a linguistic minority in the region. They have also learned medicinal plant knowledge from Pathans, as these groups have lived together for centuries and mutually negotiated and exchanged. This finding contradicts the widely accepted paradigm that the knowledge of linguistic minorities tends to adapt with that of the majority group in multicultural environments and retain negligible idiosyncratic uses. Here, we see a paradigm shift that could have some implications for the Ormur. For instance, the strong attachment of the Ormur community to their quoted medicinal plants may be used to inform policymakers to focus on their plant-based cultural heritage since these may also interfere with the use of and adherence to prescribed biomedicine [34].

Fig. 3

Venn diagram: a revealing the number of unique and common species among Ormurs and Pathans, b showing the number of species used in the same (shared) or different ways (not shared) between the two ethnic groups

Fig. 4

The overlap between the use of medicinal plants which were a collected in the wild, b cultivated, and c imported from other areas

The current research findings also show that Ormur multilingualism may have enhanced the incorporation of Pathan folk remedies into their repertoire: those plants “of their own origin” plus those of Pathans, with whom they have lived for centuries. We argue that Ormurs may have absorbed Pathan’s knowledge of medicinal plants as they can speak Pashto, and thus, they might have learned from Pathans. Pathans, however, cannot speak the Ormuri language; therefore, they do not have the same ability to access medicinal knowledge of Ormur regarding medicinal plants.

Their local plant nomenclature seems to confirm that since Ormurs have adopted the plant names of Pathans. (47 plant names are shared with Pathans.) The first author, whose mother tongue is a Waziristani dialect of Pashto, could easily recognise that Ormurs adopted plant names from Pashto as widely spoken in the entire area of Waziristan and Kaniguram. In our previous ethnobotanical study of wild food plants, our research group found several idiosyncratic uses among Ormurs [6], thus confirming the hypothesis of double ethnobotany, including original elements and Pathan/Pashto elements. Even though the Ormur retains more knowledge of medicinal plants as compared to Pathans, it is worth mentioning that local ethnobotanical knowledge of medicinal plants is highly threatened among both communities, where we could see that most of the plants were reported by only one or two informants among both ethnic groups. However, Ormurs still retain local knowledge of medicinal plants, demonstrating their strong attachment to the traditional medical system until recently. For the last two decades, large-scale mass migration has been driven by the “war on terror”, which has caused local communities to move out of these areas, ultimately affecting the daily life activities, local cultural practices, and natural resource management of Ormurs and Pathans, which in turn may have negatively impacted the traditional knowledge on natural resources of the two linguistic groups.

It is worth mentioning, however, that the characteristic uses of these plants among the Ormur may represent their ancestral knowledge and the knowledge that was possibly learned to some extent from different sources. It is also important to note that all the idiosyncratic uses of medicinal plants quoted by the Ormur people were only reported by a single informant, except two taxa, Adiantum capillus-veneris and Peganum harmala, which were cited by 4 and 2 participants, respectively. Very few of the reported plants mentioned by the participants were currently used; most were used in the past. One of the main reasons for the erosion of local plant knowledge may be the globalisation and capillary diffusion of modern medical systems, which has led people to rely on Western biomedicines. Ormurs reported more use reports (346 URs) than Pathans (261 URs), although both communities have equal access to the official health system in the study area. This difference might be due to the Ormur historical socio-cultural stratification of their LEK/TEK and their disadvantaged economic conditions, resulting in possibly less access to the modern healthcare system, making them more dependent on local medicinal plants.

We also compared the wild, cultivated, and imported plants among the two studied communities. We observed that Ormurs used more medicinal taxa in each of the three categories, thus indicating a comprehensive, rich knowledge of medicinal plants.

Local ecological knowledge and language: a mutating complex

LEK is a mutating complex that changes over time and space. In today’s world, local plant knowledge of medicinal resources is highly vulnerable to change as modern and Western medicines have changed the global trend, and people rely more on these medicines, causing them to abandon traditional herbal therapies. For instance, during the survey, many participants confirmed that they do not need to prepare any traditional treatments at home as they may find doctors and medical practitioners in local clinics and pharmacies. People also asserted that extensive outmigration due to the “war on terror”—the guerrilla initiated by religious extremist groups two decades ago—has driven people to live in cities where they are more exposed to allopathic medicine, and this has greatly influenced medicinal plant knowledge, as evidenced by the fact that people have difficulty recalling the local names of medicinal plants. They have likely forgotten much of the local medicinal knowledge related to local plant resources, and we may expect that medicinal knowledge associated with the more common and frequently used taxa still resides in their memories, which they reported in this study.

The drivers of change in local plant knowledge might differ between the two communities. For instance, the medical ethnobotany of the two communities may have been affected by the introduction of exotic uses of the reported plants, as we observed the impact of the dominant Pathan culture on Ormurs. Therefore, not only can we say that the idiosyncratic uses of specific plants quoted by Ormurs cannot be considered cultural markers, but that they might have acquired local plant knowledge from other cultural groups through occasional intermarriage or symbiotic relationships with them, as also explained by the results of our previous studies [3, 35,36,37].

We observed that Ormurs have mostly adopted local Pathan names for the reported plant species, and we have recorded twenty-seven idiosyncratic plant names among Ormur (Table 3). Earlier, studying wild food ethnobotany among the same groups, we found that some phytonyms were linked to Persian and Kurdish plant names [6]. The use of Pashto as the lingua franca formed the foundation for sharing local knowledge on medicinal plants and has caused the homogenisation of knowledge of the quoted medicinal plants. Linguistic adaptation represents one type of socio-cultural adaptation made during socio-cultural negotiations, which can be observed in recent times via intermarriages. During our previous food ethnobotanical survey, we found that the Ormur people are more exposed to other cultural groups as they have migrated from their hometown to nearby cities because of the unstable security situation in the area, and now their knowledge and language are more threatened than ever before (see also [6]). Many participants had forgotten some important linguistic terms, others could not name some important plants, and others mentioned misleading local names for certain more popular plants, all revealing the dire situation of the minority language and related cultural knowledge. This finding also indicates linguistic homogenisation among the individuals of the two groups and the dominant impact of Pashto, the lingua franca, in the study area.

Table 3 The list of the plants that reported with different names among the two communities

Morgenstierne [7] asserted that Ormuri speakers of both Kaniguram and Logar in Afghanistan have been significantly affected by their Pashtun neighbours and have freely borrowed numerous words from them. Kieffer [38] declared that the Ormuri language has reached the final stage of its resistance; it is used only in the home, and even there, due to exogamous marriages, its use is diminishing.

Many elderly Ormur participants mentioned that their close relationships with Pathans had influenced language and local ecological knowledge. In contrast, others revealed that migration further assisted the loss of mental lexicons, including terms related to local plants and their uses. Stringer affirmed the mental lexicon as a storehouse of traditional ecological knowledge (for an in-depth discussion, see [39] and references therein). He further argues that preserving the environment is essential for revitalising languages attached knowledge. Overall, the “war on terror” in Waziristan has had a significant negative impact on the traditional plant knowledge of the local population, and much of this knowledge is at risk of being lost permanently. We observed that the post-war rehabilitation process has caused significant changes in daily life practices, which may have affected local ecological knowledge.

Even today, the security situation is highly fragile and local communities tend to live in safe areas or have migrated. We found that the younger generations do not hold traditional medicinal knowledge, and they often leave mountain areas and move to cities. Scientists have affirmed that language has a vital role in shaping local ecological knowledge, which also includes the use of medicinal plants [40,41,42,43].

The rapid mass migration from the area has become one of the main factors weakening the connection between people and nature, ultimately impacting the local plant knowledge. In the present study, we discovered that a different factor contributes to the mutation of local ecological knowledge. The study area has suffered from the “war on terror” for the last two decades. Local communities have been migrating to cities and leaving the area for years. They may have also learned knowledge from other cultural groups with whom they have interacted.

Thus, we can see that the LEK of the studied communities is threatened [6] as the citation frequency is minor for each plant.

LEK and its conservation

The conservation of local medical knowledge in medical education, particularly that related to providing public healthcare to local communities, especially minorities and other underprivileged communities, has to consider these communities’ cultural knowledge, beliefs, and practices [44,45,46]. In the study area, biocultural heritage related to medicinal plants in the two communities is facing severe threats, especially among Ormurs, a linguistic minority, who are under twofold pressure. On the one hand, their medicinal knowledge is gradually fading. At the same time, they have adopted the Pashto language and have forgotten much of the local plant nomenclature (see, for instance, [6]). In this regard, conserving and revitalising cultural knowledge through possible institutions is deemed necessary, and ethnobotanists should play an important role in convincing the local educational authorities to make the LEK part of educational activities. Indeed, among ethnobotanists, the narrative of conservation through education has been gaining considerable attention. However, most of society, including botany students, still does not know the importance of local or traditional medicinal knowledge. Therefore, certain initiatives will have to be adopted not only to protect local plant knowledge from further erosion, but it will also improve the quality of primary health care through cultural competency training. Above all, policymakers must be sincere in tackling the extinction of local knowledge systems and must support and design culturally sensitive educational and medical programmes. Moreover, culturally competent healthcare fosters sensitivity to the cultural context of sickness and healing, including self-treatment with medicinal plants. It encourages practitioners to negotiate treatment acceptable to both clinician and patient [46].

Local people must take an active part in protecting biocultural heritage and natural resources. This will effectively happen if we educate people about the cultural, ecological, and economic values of natural resources and the impacts of human activities on them, as well as teach them the skills and knowledge they need to conserve resources effectively. Different platforms could be utilised; for instance, place-based courses on biocultural conservation can be taught in schools, and in an informal way, communities could also be involved through public awareness campaigns and on-the-ground conservation training for local communities. In particular, local schools are a vital platform for learning and revitalising local plant knowledge, as we have some insight from previous research work in the Hindukush [47].

According to the biological convention’s message, we must cross many obstacles to promote healthy local ecological practices. As stated by the UN Agenda 2030, it is important to preserve cultural heritage for social sustainability and to protect nature and the ecosystem [48]. The issue of conservation cannot be addressed by merely revolving around academia. Still, instead, we need bold steps to promote and disseminate botanical information in schools and other educational institutions. Several scientists have clearly articulated this and have made it clear that it has clear policy implications [18, 49, 50]. Until we educate our society about the cultural and economic importance of protecting local cultural resources and promoting the knowledge related to these natural resources, our claim to be effective in conserving nature is hollow. For a sustainable future on this planet, everyone has to be concerned in this regard. Ecological transition is a timely call for which we must take on board the local communities to make them economically independent. Brayboy and Castagno [51] stated that indigenous ways of knowing are neither inferior nor superior to Western ways; they are different perspectives that need to be acknowledged rather than trying to justify their inclusion in Western education. Therefore, we argue that if the curriculum is aligned with local cultural and ecological realities, it will promote children’s connection to science, which is crucial but missing in schools where examples are infrequent and usually used only to illustrate isolated concepts [52]. In the ongoing context, if medicinal plants and their commercialisation are valued, we can obtain very positive results in alleviating poverty, and it will also help biocultural conservation. More people will be connected to nature and the local resources, which is important for the social sustainability of this highly fragile mountain region, as the large mass migration from the area is posing serious population threats to nearby urban areas.

Limitations of the study

In this study, we only interviewed the male community members. We were not allowed to conduct interviews with women because of the strict practice of Parda (“veil”), but we may expect that medicinal knowledge is quite gendered, and women could be more knowledgeable than men. Many research studies have demonstrated the important role of women in holding and retaining medicinal plant knowledge [53,54,55,56,57,58,59,60]. It has been affirmed that medicinal plant knowledge is most often the cultural domain of women because of their role in providing care within the household [53,54,55, 61, 62], which includes, as part of their labour and domestic activities, the management of plant-based resources, leading to extensive knowledge of locally practised herbal therapies [53, 54, 58]. Thus, they retain more knowledge of medicinal plants [53, 55,56,57], and their knowledge could be epistemologically different than that of men [54].

Conclusion

The current study revealed a significant homogenisation of local medicinal knowledge among the two studied ethnic groups. Ormurs have retained comparatively rich expertise of the quoted plants compared to Pathans, which, on the one hand, might suggest that they have kept their traditional medical knowledge. On the other hand, it may indicate that they have absorbed a significant body of exotic knowledge on the recorded medicinal plants, thus proving our hypothesis that the medicinal plant knowledge of Ormur has been significantly affected by their close neighbours. However, it is interesting to note that the local plant nomenclature among Ormurs has been highly influenced by Pathans, demonstrating their socio-cultural adaptation, which might be a driver of learning exotic medicinal knowledge regarding natural resources. This study indicates that local plant knowledge is highly threatened due to the invasion of Western medicine into the area during the last few decades. Other drivers of change might include the extensive mass migration from the area over the previous two decades because of the ongoing “war on terror”, which has limited local communities’ access to traditional lands and natural resources, making medicinal plant knowledge more fragile. We suggest that policy measures should be taken to preserve the fading cultural heritage and help conserve the threatened medicinal flora across the region. Further ethnographic research should be conducted, especially studies that focus on recording the medicinal plant knowledge among women, as they are considered potential knowledge holders of herbal medicines. It is equally important to investigate the local plant knowledge in other parts of Waziristan to preserve the fading cultural heritage among Pathans, which is highly threatened.